利奈唑胺和万古霉素对革兰阳性菌所致脓毒血症治疗作用的Meta分析

目的:评估利奈唑胺与万古霉素治疗革兰阳性菌所致脓毒血症的有效性和安全性。方法:从Pubmed、CNKI、万方数据库获得关于利奈唑胺与万古霉素治疗革兰阳性菌所致脓毒血症的随机对照试验(RCTs)的文献。评估2种药物对脓毒血症的临床治愈率、微生物学清除率、对金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌清除率及不良反应发生率。结果:共纳入的8个随机对照试验,包括3 668个革兰阳性球菌脓毒血症感染患者。Meta分析结果显示,在临床可评估患者中,与万古霉素比较,利奈唑胺在临床治愈率(OR=1.18,95% CI(0.82-1.71),P=0.37)、微生物学总治愈率(OR=1.26,95%CI(0.97-1.65),P=0.09)、对金黄色葡萄球菌细菌(MRSA)清除率(OR=1.24,95%CI(0.72-2.11),P=0.44)和对耐甲氧西林金黄色葡萄球菌细菌清除率(OR=1.58,95%CI(0.99-2.54),P=0.06)及不良反应发生率(OR=0.96,95%CI(0.80-1.14),P=0.63)与万古霉素相当。结论:在治疗革兰阳性球菌(例如金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌)导致的脓毒血症中,利奈唑胺与万古霉素的治疗效果相当。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。

Effects of linezolid and vancomycin against sepsis induced by Gram-positive bacteria:a systematic review and meta-analysis

OBJECTIVE To evaluate the efficacy and safety of linezolid versus vancomycin against sepsis caused by gram-positive bacteria.METHODS Data were obtained from Pubmed,CNKI,Wangfang database. Randomized controlled studies involving the use of linezolid versus vancomycin were included in the study.Outcomes evaluated consisted of clinical cure,microbiological eradication,side effects,Staphylococcus aureus eradication,and methicillin resistant Staphylococcus aureus (MRSA) eradication.RESULTS Eight randomized trials with a total of 3 668 patients were included.Meta-analysis showed that linezolid and vancomycin had similar clinical cure rates in clinical evaluation in patients at the visit at the end of treatment (OR=1.18,95% CI (0.82-1.71),P=0.37).In microbiologically evaluable patients, the success rate of microbiological treatment (OR=1.26,95%CI (0.97-1.65),P=0.09),eradication rate of Staphylococcus aureus (OR=1.24,95%CI (0.72-2.11),P=0.44) and MRSA eradication rate (OR=1.58,95%CI (0.99-2.54),P=0.06),effective rates of linezolid and vancomycin were similar. Adverse effects data showed that there was no significant difference between vancomycin and linezolid (OR=0.96,95%CI (0.80-1.14),P=0.63).CONCLUSION In the treatment against gram-positive bacterial infection, linezolid and vancomycin have equivalent effects.Though we still need larger sample size, more rigorously designed and randomized double-blind controlled trials for further verification and support.