Liu Qi, He Dongxia, Wang Lei, Wu Yuewei, Liu Xian, Yang Yahan, Chen Zhizhi, Dong Zhan, Luo Ying, Song Yuzhu
College of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China.
Graduate School, Kunming University of Science and Technology, Kunming 650500, China.
Antibiotics (Basel). 2024 Sep 10;13(9):866. doi: 10.3390/antibiotics13090866.
Vancomycin is a first-line drug for the treatment of MRSA infection. However, overuse of vancomycin can cause bacteria to become resistant, forming resistant strains and making infections more difficult to treat. This study aimed to evaluate the efficacy and safety of different antibiotics in the treatment of MRSA infections and to compare them, mainly with vancomycin, to find better vancomycin alternatives.
All studies were obtained from the PubMed and Embase databases from inception to 13 April 2023. The three comprehensive indicators of clinical cure success rate, clinical microbiological success rate, and adverse reactions were evaluated, and the clinical cure success rates of three disease types, complex skin and skin structure infections (cSSSIs), complex skin and soft tissue infections (cSSTIs), and pneumonia, were analyzed in subgroups. All statistical analyses were performed using R and STATA 14.0 software for network meta-analysis.
A total of 38 trials with 6281 patients were included, and 13 drug treatments were evaluated. For MRSA infections, the results of network meta-analysis showed that the clinical success rates of linezolid, the combination of vancomycin and rifampin, and the combination of minocycline and rifampin were better than that of vancomycin (RR 1.71; 95%-CI 1.45-2.02), (RR 2.46; 95%-CI 1.10-5.49) (RR, 2.77; 95%-CI 1.06-7.21). The success rate of clinical microbiological treatment with vancomycin was inferior to that with telavancin (RR 0.74; 95%-CI 0.55-0.99). Linezolid had a higher rate of adverse reactions than teicoplanin (RR 5.35; 95%-CI 1.10-25.98). Subgroup analysis showed that vancomycin had a lower clinical success rate than linezolid in the treatment of MRSA-induced cSSSIs, cSSTIs, and pneumonia (RR 0.59; 95%-CI 0.44-0.80) (RR 0.55; 95%-CI 0.35-0.89) (RR 0.55; 95%-CI 0.32-0.93).
This systematic review and NMA provide a new comparison framework for the clinical treatment of MRSA infection. The NMA suggests that linezolid may be the antibiotic of choice for the treatment of MRSA infections, with the ability to improve clinical and microbiological success rates despite its disadvantage in terms of adverse effects. At the same time, the combination of minocycline and rifampicin may be the most effective drug to treat MRSA-induced cSSSIs, tedizolid may be the best drug to treat MRSA-induced cSSTIs, and the combination of vancomycin and rifampicin may be the most effective treatment for MRSA-induced pneumonia. More high-quality studies are still needed in the future to further identify alternatives to vancomycin.
PROSPERO registration number CRD42023416788.
万古霉素是治疗耐甲氧西林金黄色葡萄球菌（MRSA）感染的一线药物。然而，过度使用万古霉素会导致细菌产生耐药性，形成耐药菌株，使感染更难治疗。本研究旨在评估不同抗生素治疗MRSA感染的疗效和安全性，并将它们主要与万古霉素进行比较，以寻找更好的万古霉素替代药物。
所有研究均从创刊至2023年4月13日从PubMed和Embase数据库中获取。评估临床治愈率、临床微生物学成功率和不良反应这三项综合指标，并对复杂皮肤及皮肤结构感染（cSSSIs）、复杂皮肤及软组织感染（cSSTIs）和肺炎这三种疾病类型的临床治愈率进行亚组分析。所有统计分析均使用R和STATA 14.0软件进行网络荟萃分析。
共纳入38项试验，涉及6281例患者，并评估了13种药物治疗方法。对于MRSA感染，网络荟萃分析结果显示，利奈唑胺、万古霉素与利福平联合用药、米诺环素与利福平联合用药的临床成功率优于万古霉素（相对风险[RR] 1.71；95%置信区间[CI] 1.45 - 2.02），（RR 2.46；9%置信区间1.10 - 5.49）（RR 2.77；95%置信区间1.06 - 7.21）。万古霉素的临床微生物学治疗成功率低于替考拉宁（RR 0.74；95%置信区间0.55 - 0.99）。利奈唑胺的不良反应发生率高于替考拉宁（RR 5.35；95%置信区间1.10 - 25.98）。亚组分析表明，万古霉素在治疗由MRSA引起的cSSSIs、cSSTIs和肺炎方面的临床成功率低于利奈唑胺（RR 0.59；95%置信区间0.44 - 0.80）（RR 0.55；95%置信区间0.35 - 0.89）（RR 0.55；95%置信区间0.32 - 0.93）。
本系统评价和网络荟萃分析为MRSA感染的临床治疗提供了一个新的比较框架。网络荟萃分析表明，利奈唑胺可能是治疗MRSA感染的首选抗生素，尽管其在不良反应方面存在劣势，但仍有提高临床和微生物学成功率的能力。同时，米诺环素与利福平联合用药可能是治疗由MRSA引起的cSSSIs最有效的药物，特地唑胺可能是治疗由MRSA引起的cSSTIs的最佳药物，万古霉素与利福平联合用药可能是治疗由MRSA引起的肺炎最有效的治疗方法。未来仍需要更多高质量的研究来进一步确定万古霉素的替代药物。
PROSPERO注册号CRD42023416788。
