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Comparative Efficacy and Safety of Vancomycin, Linezolid, Tedizolid, and Daptomycin in Treating Patients with Suspected or Proven Complicated Skin and Soft Tissue Infections: An Updated Network Meta-Analysis
Infectious Diseases and Therapy ( IF 5.4 ) Pub Date : 2021-06-18 , DOI: 10.1007/s40121-021-00456-0
Jingjuan Feng 1, 2 , Feng Xiang 2, 3 , Jian Cheng 2, 3 , Yeli Gou 2, 3 , Jun Li 1
Affiliation  

Introduction

Skin and soft structure infections (SSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) pose serious health risks and cause significant cost burdens, and a conclusive recommendation about antibiotics has not yet been generated. Therefore, we performed this updated network meta-analysis to determine the preferred drug for the treatment of MRSA-caused SSTIs.

Methods

We searched PubMed, Embase, and Cochrane Library to identify any potentially eligible randomized controlled trials (RCTs) investigating the comparative efficacy and safety of any two of vancomycin, linezolid, tedizolid, and daptomycin in MRSA-caused SSTIs. All statistical analyses were conducted with RevMan, ADDIS, and STATA software.

Results

Twenty eligible RCTs involving 7804 patients were included for the final analysis. Direct meta-analysis suggested that linezolid was superior to vancomycin in improving clinical (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.07–1.99; P = 0.02) and microbiological (OR, 1.89; 95% CI, 1.24–2.86; P = 0.003) success, which were all confirmed by network meta-analyses. No statistical differences were identified regarding other comparisons. Meanwhile, there were no significant differences between any two antibiotics related to safety. Moreover, ranking probabilities indicated that linezolid had the highest probability of being ranked best in terms of clinical and microbiological success.

Conclusion

Based on the limited evidence, linezolid may be a preferred antibiotic for the treatment of MRSA-caused SSTIs because it showed superiority in clinical and microbiological success without difference regarding safety.



中文翻译:

万古霉素、利奈唑胺、泰地唑胺和达托霉素治疗疑似或确诊的复杂性皮肤和软组织感染患者的疗效和安全性比较:一项更新的网络荟萃分析

介绍

由耐甲氧西林金黄色葡萄球菌(MRSA) 引起的皮肤和软结构感染 (SSTI)会带来严重的健康风险并造成巨大的成本负担,目前尚未形成关于抗生素的结论性建议。因此,我们进行了这项更新的网络荟萃分析,以确定治疗 MRSA 引起的 SSTI 的首选药物。

方法

我们检索了 PubMed、Embase 和 Cochrane 图书馆,以确定任何可能符合条件的随机对照试验 (RCT),以调查万古霉素、利奈唑胺、泰地唑胺和达托霉素中任意两种在 MRSA 引起的 SSTI 中的比较疗效和安全性。所有统计分析均使用 RevMan、ADDIS 和 STATA 软件进行。

结果

最终分析纳入了 20 项符合条件的 RCT,涉及 7804 名患者。直接荟萃分析表明,利奈唑胺在改善临床(比值比 [OR],1.46;95% 置信区间 [CI],1.07-1.99;P  = 0.02)和微生物学(OR,1.89;95% CI, 1.24–2.86;P  = 0.003)成功,这些都得到了网络荟萃分析的证实。其他比较没有发现统计学差异。同时,任何两种抗生素在安全性方面均无显着差异。此外,排名概率表明,利奈唑胺在临床和微生物学成功方面排名最高的概率最高。

结论

基于有限的证据,利奈唑胺可能是治疗 MRSA 引起的 SSTI 的首选抗生素,因为它在临床和微生物学成功方面显示出优势,而安全性没有差异。

更新日期:2021-06-18
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