Menarini Ricerche Spa, Florence, Italy.
Menarini Industrie Farmaceutiche Riunite, Via Sette Santi 1/3, 50131, Florence, Italy.
BMC Infect Dis. 2021 Oct 5;21(1):1036. doi: 10.1186/s12879-021-06736-x.
Delafloxacin is a novel fluoroquinolone with broad antibacterial activity against pathogens causing acute bacterial skin and skin structure infections (ABSSSI). This network meta-analysis (NMA) was conducted to evaluate the relative efficacy of delafloxacin versus other comparators used for managing patients with ABSSSI.
A systematic literature review was conducted to identify randomised controlled trials (RCTs) evaluating adults (≥ 18 years) with ABSSSI, complicated SSSI (cSSSI), complicated skin and soft tissue infections (cSSTI) or severe cellulitis with pathogen of gram-positive, gram-negative, or mixed aetiology. OVID MEDLINE, Embase, Epub Ahead of Print, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews were searched from inception through 12 April 2019. A feasibility assessment was conducted, followed by an NMA, which was run in a Bayesian framework. The interventions included in the NMA encompassed monotherapy or combination therapies of amoxicillin/clavulanate, ampicillin/sulbactam, ceftaroline, ceftobiprole, dalbavancin, daptomycin, delafloxacin, fusidic acid, iclaprim, linezolid, omadacycline, oxacillin + dicloxacillin, standard therapy, tedizolid, telavancin, tigecycline, vancomycin, vancomycin + aztreonam and vancomycin + linezolid.
A feasibility assessment was performed and evidence networks were established for composite clinical response (n = 34 studies), early clinical response (n = 16 studies) and microbiological response (n = 14 studies) in the overall study population, composite clinical response (n = 4 studies) in obese subpopulation and for composite clinical response (n = 18 studies) and microbiological response (n = 14 studies) in patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. Delafloxacin performed significantly better than fusidic acid, iclaprim, vancomycin, and ceftobiprole for composite clinical response. Delafloxacin was comparable to dalbavancin, daptomycin, fusidic acid, iclaprim, linezolid, omadacycline, tedizolid, vancomycin, vancomycin + aztreonam and vancomycin + linezolid in the analysis of early clinical response, whereas for microbiological response, delafloxacin was comparable to all interventions. In the obese subpopulation, the results favoured delafloxacin in comparison to vancomycin, whilst the results were comparable with other interventions among the MRSA subpopulation.
Delafloxacin is a promising new antibiotic for ABSSSI demonstrating greater improvement (composite clinical response) compared to ceftobiprole, fusidic acid, iclaprim, telavancin and vancomycin and comparable effectiveness versus standard of care for all outcomes considered in the study.
达托霉素是一种新型氟喹诺酮类药物，对引起急性细菌性皮肤和皮肤结构感染（ABSSSI）的病原体具有广泛的抗菌活性。本网络荟萃分析（NMA）旨在评估达托霉素与用于治疗 ABSSSI 患者的其他对照药物的相对疗效。
系统检索评估成人（≥18 岁）ABSSSI、复杂性皮肤和软组织感染（cSSTI）或伴有革兰阳性、革兰阴性或混合病因的严重蜂窝织炎的随机对照试验（RCT）。检索 OVID MEDLINE、Embase、Epub 提前在线、Cochrane 对照试验中心注册库和 Cochrane 系统评价数据库，检索时间从建库至 2019 年 4 月 12 日。进行可行性评估，然后进行 NMA，NMA 在贝叶斯框架下运行。NMA 中包含的干预措施包括阿莫西林/克拉维酸、氨苄西林/舒巴坦、头孢洛林、头孢托罗匹酯、达托霉素、达普霉素、达托霉素、夫西地酸、依克拉普林、利奈唑胺、奥马环素、苯唑西林/双氯西林、标准治疗、替加环素、替考拉宁、替格环素、万古霉素、万古霉素/氨曲南和万古霉素/利奈唑胺的单药或联合治疗。
进行了可行性评估，并为总体研究人群的复合临床反应（n=34 项研究）、早期临床反应（n=16 项研究）和微生物学反应（n=14 项研究）建立了证据网络，为肥胖亚组的复合临床反应（n=4 项研究）和耐甲氧西林金黄色葡萄球菌（MRSA）感染患者的复合临床反应（n=18 项研究）和微生物学反应（n=14 项研究）建立了证据网络。达托霉素在复合临床反应方面的表现明显优于夫西地酸、依克拉普林、万古霉素和头孢托罗匹酯。达托霉素在早期临床反应分析中与达巴万星、达普霉素、夫西地酸、依克拉普林、利奈唑胺、奥马环素、替加环素、万古霉素、万古霉素/氨曲南和万古霉素/利奈唑胺相当，而在微生物学反应方面，达托霉素与所有干预措施相当。在肥胖亚组中，与万古霉素相比，达托霉素的结果更为有利，而在 MRSA 亚组中，与其他干预措施的结果相当。
达托霉素是一种有前途的新型抗生素，在 ABSSSI 方面的改善更为显著（复合临床反应），优于头孢托罗匹酯、夫西地酸、依克拉普林、替拉万星和万古霉素，与研究中考虑的所有结局的标准治疗相比，其疗效相当。
