Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan.
Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan; Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University Hospital, Aichi, Japan.
J Glob Antimicrob Resist. 2021 Mar;24:98-105. doi: 10.1016/j.jgar.2020.12.009. Epub 2021 Jan 2.
American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines suggest that linezolid (LZD) is preferred over vancomycin (VCM) for treating methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. We conducted a systematic review and comparative meta-analysis to compare VCM and LZD efficacy against proven MRSA pneumonia.
We searched EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed up to November 2019. The outcomes of the meta-analysis were mortality, clinical cure, microbiological evaluation, and adverse events.
Seven randomized controlled trials (RCTs) with a total of 1239 patients and eight retrospective cohort or case-control studies (CSs) with a total 6125 patients were identified. Clinical cure and microbiological eradication rates were significantly increased in patients treated with LZD in RCTs (clinical cure: risk ratio (RR) = 0.81, 95% confidential interval (CI) = 0.71-0.92; microbiological eradication: RR = 0.71, 95% CI = 0.62-0.81) and CSs (clinical cure: odds ratio (OR) = 0.35, 95% CI = 0.18-0.69). However, mortality was comparable between patients treated with VCM and LZD in RCTs (RR = 1.08, 95% CI = 0.88-1.32) and CSs (OR = 1.20, 95% CI = 0.94-1.53). Likewise, there was no significant difference in adverse events between VCM and LZD in CSs (thrombocytopenia: OR = 0.95, 95% CI = 0.50-1.82; nephrotoxicity: OR = 1.72, 95% CI = 0.85-3.45).
According to our meta-analysis of RCTs and CSs conducted worldwide, we found robust evidence to corroborate the IDSA guidelines for the treatment of proven MRSA pneumonia.
美国胸科学会/传染病学会（ATS/IDSA）指南建议利奈唑胺（LZD）优于万古霉素（VCM）治疗耐甲氧西林金黄色葡萄球菌（MRSA）肺炎。我们进行了系统评价和比较荟萃分析，以比较 VCM 和 LZD 对确诊的 MRSA 肺炎的疗效。
我们检索了 EMBASE、CINAHL、Cochrane 对照试验中心注册库（CENTRAL）和 PubMed，检索时间截至 2019 年 11 月。荟萃分析的结局指标为死亡率、临床治愈率、微生物学评估和不良事件。
共纳入了 7 项随机对照试验（RCT），共计 1239 例患者和 8 项回顾性队列或病例对照研究（CSs），共计 6125 例患者。在 RCTs 中，LZD 治疗组的临床治愈率和微生物学清除率显著提高（临床治愈率：风险比（RR）=0.81，95%置信区间（CI）=0.71-0.92；微生物学清除率：RR=0.71，95%CI=0.62-0.81）和 CSs（临床治愈率：比值比（OR）=0.35，95%CI=0.18-0.69）。然而，在 RCTs（RR=1.08，95%CI=0.88-1.32）和 CSs（OR=1.20，95%CI=0.94-1.53）中，VCM 和 LZD 治疗组的死亡率无显著差异。同样，在 CSs 中，VCM 和 LZD 之间的不良事件发生率也无显著差异（血小板减少症：OR=0.95，95%CI=0.50-1.82；肾毒性：OR=1.72，95%CI=0.85-3.45）。
根据我们对全球 RCT 和 CSs 的荟萃分析，我们发现了强有力的证据来支持 IDSA 指南治疗确诊的 MRSA 肺炎。
