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題名 Daptomycin versus linezolid for treatment of vancomycin-resistant enterococcal bacteremia: Systematic review and meta-analysis 作者 Lin, Hsin-Yi
林馨怡
Wang, J.-T.
Chuang, Y.-C.貢獻者 經濟系 關鍵詞 Daptomycin; Linezolid; Meta-analysis; Vancomycin-resistant enterococci 日期 2014-12 上傳時間 3-六月-2015 12:32:44 (UTC+8) 摘要 Linezolid, which has bacteriostatic activity, is approved for the treatment of vancomycin-resistant enterococci (VRE) infections. Meanwhile, daptomycin exerts bactericidal activity against VRE, but is not approved for the treatment of VRE bacteremia. Only a few studies with small sample sizes have compared the effectiveness of these drugs for treatment of VRE bacteremia. Methods: PubMed, EMBASE, and the Cochrane Library were searched for studies of VRE bacteremia treatment published before January 1, 2014. All studies reporting daptomycin and linezolid treatment outcomes simultaneously were included. The endpoints were mortality and microbiological cure. The adjusted odds ratios (aORs) of mortality in daptomycin- and linezolid-treated patients were extracted if available. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for all outcomes using a random-effects model. Results: Thirteen studies (532 patients receiving daptomycin, 656 patients receiving linezolid) met the selection criteria. All studies had retrospective cohort designs and relatively small sample sizes. Eight studies compared the aORs of mortality in daptomycin- and linezolid-treated patients. Four studies were published as conference papers and there was significant heterogeneity among these studies ((I2 = 63%, p = 0.04). Daptomycin use was not associated with better microbiological cure (daptomycin. linezolid, OR: 0.67, 95% CI: 0.42-1.06, 0.09). However, mortality was higher in patients receiving daptomycin (OR: 1.43, 95% CI: 1.09-1.86, 0.009). Subgroup analysis of studies that reported aORs indicated that daptomycin was associated with higher mortality (OR: 1.59, 95% CI: 1.02-2.50, 0.04). There was no evidence of publication bias, but all enrolled studies were retrospective, had small sample sizes, and had substantial limitations. Conclusions: Although limited data is available, the current meta-analysis shows that linezolid treatment for VRE bacteremia was associated with a lower mortality than daptomycin treatment. However, the results should be interpreted cautiously because of limitations inherent to retrospective studies and the high heterogeneity among studies. A large randomized trial is needed to confirm the present results. 關聯 BMC Infectious Diseases, 14(1), 650-669, 論文編號 687 資料類型 article DOI http://dx.doi.org/10.1186/s12879-014-0687-9 dc.contributor 經濟系 - dc.creator (作者) Lin, Hsin-Yi - dc.creator (作者) 林馨怡 zh_TW dc.creator (作者) Wang, J.-T. en_US dc.creator (作者) Chuang, Y.-C. en_US dc.date (日期) 2014-12 - dc.date.accessioned 3-六月-2015 12:32:44 (UTC+8) - dc.date.available 3-六月-2015 12:32:44 (UTC+8) - dc.date.issued (上傳時間) 3-六月-2015 12:32:44 (UTC+8) - dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/75547 - dc.description.abstract (摘要) Linezolid, which has bacteriostatic activity, is approved for the treatment of vancomycin-resistant enterococci (VRE) infections. Meanwhile, daptomycin exerts bactericidal activity against VRE, but is not approved for the treatment of VRE bacteremia. Only a few studies with small sample sizes have compared the effectiveness of these drugs for treatment of VRE bacteremia. Methods: PubMed, EMBASE, and the Cochrane Library were searched for studies of VRE bacteremia treatment published before January 1, 2014. All studies reporting daptomycin and linezolid treatment outcomes simultaneously were included. The endpoints were mortality and microbiological cure. The adjusted odds ratios (aORs) of mortality in daptomycin- and linezolid-treated patients were extracted if available. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for all outcomes using a random-effects model. Results: Thirteen studies (532 patients receiving daptomycin, 656 patients receiving linezolid) met the selection criteria. All studies had retrospective cohort designs and relatively small sample sizes. Eight studies compared the aORs of mortality in daptomycin- and linezolid-treated patients. Four studies were published as conference papers and there was significant heterogeneity among these studies ((I2 = 63%, p = 0.04). Daptomycin use was not associated with better microbiological cure (daptomycin. linezolid, OR: 0.67, 95% CI: 0.42-1.06, 0.09). However, mortality was higher in patients receiving daptomycin (OR: 1.43, 95% CI: 1.09-1.86, 0.009). Subgroup analysis of studies that reported aORs indicated that daptomycin was associated with higher mortality (OR: 1.59, 95% CI: 1.02-2.50, 0.04). There was no evidence of publication bias, but all enrolled studies were retrospective, had small sample sizes, and had substantial limitations. Conclusions: Although limited data is available, the current meta-analysis shows that linezolid treatment for VRE bacteremia was associated with a lower mortality than daptomycin treatment. However, the results should be interpreted cautiously because of limitations inherent to retrospective studies and the high heterogeneity among studies. A large randomized trial is needed to confirm the present results. - dc.format.extent 1840209 bytes - dc.format.mimetype application/pdf - dc.relation (關聯) BMC Infectious Diseases, 14(1), 650-669, 論文編號 687 - dc.subject (關鍵詞) Daptomycin; Linezolid; Meta-analysis; Vancomycin-resistant enterococci - dc.title (題名) Daptomycin versus linezolid for treatment of vancomycin-resistant enterococcal bacteremia: Systematic review and meta-analysis - dc.type (資料類型) article en dc.identifier.doi (DOI) 10.1186/s12879-014-0687-9 - dc.doi.uri (DOI) http://dx.doi.org/10.1186/s12879-014-0687-9 -
