摘要
目的采用Meta分析法对现已发表的利用利奈唑胺和万古霉素治疗革兰阳性球菌感染的文献进行综合分析,评价利奈唑胺的疗效及安全性是否优于万古霉素。方法计算机检索MEDLINE、EMBASE、OVID、Cochrane library和CNKI等数据库,并追查所有纳入文献的参考文献,进行Meta分析。纳入比较利奈唑胺和万古霉素治疗革兰阳性球菌感染疗效的随机对照试验。结果共纳入12个随机对照试验,包括5863个革兰阳性球菌感染患者。Meta分析结果显示,在临床可评估患者中,治疗结束后[OR=1.98,95%CI(1.32,2.98),P=0.001]及随访结束后[OR=1.34,95%CI(1.01,1.76),P=0.04]利奈唑胺的临床治愈率优于万古霉素,而在意向性治疗患者中,随访结束后利奈唑胺其临床治愈率亦优于万古霉素[OR=1.20,95%CI(1.01,1.43),P=0.04]。同时,在微生物学可评估患者中,其随访结束后的微生物学总治愈率[OR=1.39,95%CI(1.12,1.73),P=0.003]、金黄色葡萄球菌清除率[OR=1.84,95%CI(1.39,2.42),P<0.0001]及肠球菌清除率[OR=5.42,95%CI(1.49,19.71),P=0.01]方面,利奈唑胺亦优于万古霉素,而在耐甲氧西林金黄色葡萄球菌(MRSA)清除率[OR=1.54,95%CI(0.97,2.45),P=0.07]、链球菌清除率[OR=0.89,95%CI(0.31,2.54),P=0.82]方面,利奈唑胺相当于万古霉素。另外,利奈唑胺与万古霉素在病死率[OR=1.07,95%CI(0.89,1.28),P=0.50]及不良反应总体发生率[OR=1.10,95%CI(0.83,1.44),P=0.52]等方面亦相当。结论在治疗革兰阳性球菌感染中,利奈唑胺疗效优于万古霉素。但还需要更严格设计的、大样本的随机双盲对照试验来进一步验证和支持。
Objective A meta-analysis of randomised controlled trials on the efficacy and safety in patients with Gram-positive cocci infections treated with linezolid versus with vancomycin. Methods The data were collected from the MEDLINE, EMBASE, OVID, the Cochrane library, and CNKI. We also handsearched relevant journals. Randomized controlled trials comparing linezolid with vancomycin in patients with Gram-positive cocci infections were eligible for inclusion. Two investigators independently assessed the quality and extracted the data. The methodological quality of trails was assessed by the Jadad-scale plus allocation concealment. Heterogeneity was examined by chi-square test. Fixed effects model or random effects model were used to pool the data. Sensitivity analyses were used in the treatment course. Results Twelve randomized controlled studies comparing linezolid with vancomycin were analyzed, focusing on the 5,863 patients with Gram-positive cocci infections. It was found by meta- analysis that, with respect to clinical treatment success, linezolid was more effective than vancomycin in clinically evaluation patients at the en.d-of-treatment visit [OR 1.98, 95%CI （1.32, 2.98）, P=0.001] and at the test-of-cure visit [OR1.34, 95%CI （1.01, 1.76）, P=0.04], and there was more effective than vancomycin in intention-to-treat patients at the test-of-cure visit [OR 1.20, 95%CI （1.01, 1.43）, P=0.04]. With respect to microbiological treatment success, linezolid was more effective than vancomycin in microbiologically evaluation patients at the test-of-cure visit [OR 1.39, 95%CI （1.12, 1.73）, P=0.003]. Additionally, empirical treatment with linezolid was associated with increased eradication rates for S. aureus strains [OR=1.84, 95%CI （1.39, 2.42）, P〈0.0001] and enterococcal species [OR=5.42, 95%CI （1.49, 19.71）, P=0.01 ] in comparison with vancomycin in microbiologically evaluation patients at the test-of-cure visit. But, there was no difference in eradication rates for MRSA strains [OR=1.54, 95%CI （0.97, 2.45）, P=0.07], Streptococcal species [OR=0.89, 95%CI （0.31, 2.54）, P=0.82]. Mortality was similar between the groups [OR=1.07, 95%CI （0.89, 1.28）, P=0.50]. Treatment with linezolid was not associated with more adverse effects in general in comparison with vancomycin [OR=1.10, 95%CI （0.83, 1.44）, P=0.52]. Conclusion Linezolid is more effective than vancomycin for treatment of patients with Gram-positive cocci infections although rigorously designed large sample size randomized double blind clinical trials are required to further demonstrate and support the conclusion.
出处
《中国抗生素杂志》
CAS
CSCD
北大核心
2012年第7期545-557,共13页
Chinese Journal of Antibiotics
