3种抗菌药治疗耐甲氧西林金黄色葡萄球菌肺炎的网状Meta分析

Antibacterial drugs in treatment of methicillin-resistant staphylococcus aureus pneumonia:A network meta-analysis of 3 kinds of drugs

目的分析万古霉素、利奈唑胺、替考拉宁3种抗菌药治疗耐甲氧西林金黄色葡萄球菌肺炎的临床疗效和安全性。方法基于ScienceDirect、MEDLINE、PubMed、考克兰图书馆、万方数据库、中国知网(CNKI)、维普等主要数据库,检索建库至2019年9月15日的万古霉素、利奈唑胺和替考拉宁治疗耐甲氧西林金黄色葡萄球菌肺炎的随机对照试验(randomized controlled trial,RCT)文献,根据预先确定的纳入和排除标准对随机对照试验进行筛选,采用Stata 15.0软件对数据进行分析。结果本研究共纳入25个中英文RCT,包括3367例患者。网状Meta分析结果显示,利奈唑胺的有效率(RR=1.22,95%CI:1.16~1.29,P=0.00)、治愈率(RR=1.48,95%CI:1.28~1.71,P=0.00)及细菌完全清除率(RR=1.22,95%CI:1.09~1.37,P=0.00)均高于万古霉素。替考拉宁与万古霉素的这3个疗效指标均无统计学差异。排序分析结果显示,利奈唑胺的有效率、治愈率及细菌完全清除率等疗效指标最优,万古霉素最差;3种药物的不良反应发生率差异无统计学意义,但是万古霉素肾损害发生率最高,利奈唑胺血小板减少发生率最高,替考拉宁血小板减少发生率最低,替考拉宁肾损害发生率也低于万古霉素(RR=0.30,95%CI:0.10~0.92,P=0.04)。结论耐甲氧西林金黄色葡萄球菌肺炎患者可优先选用利奈唑胺,若伴有肾功能不全或者血小板基础值较低,则宜优先选用替考拉宁。

Objective To evaluate the efficacy and safety of 3 antibacterial drugs including vancomycin,linezolid and teicoplanin in treatment of methicillin-resistant staphylococcus aureus(MRSA)pneumonia.Methods Randomized controlled trials(RCTs)about vancomycin,linezolid and teicoplanin for the treatment of MRSA pneumonia were searched from ScienceDirect,MEDLINE,PubMed,the Cochrane Library,WanFang Data,CNKI,VIP Database and related references from initiation to September 15th 2019.The RCTs were screened according to the predefined inclusion and exclusion criteria,and the data were analyzed by Stata 15.0.Results Totally 25 RCTs published in Chinese or English involving 3367 patients were included.Network meta-analysis demonstrated that linezolid was significantly superior to vancomycin on effective rate(RR=1.22,95%CI:1.16-1.29,P=0.00),cure rate(RR=1.48,95%CI:1.28-1.71,P=0.00),and complete bacteria clearance rate(RR=1.22,95%CI:1.09-1.37,P=0.00).Probability ranking results showed that linezolid was the best and vancomycin was the worst in terms of 3 therapeutic indicators.There was no significant difference in the incidence of adverse reactions among the three drugs,but vancomycin had the highest incidence of renal damage,and linezolid had the highest incidence of thrombocytopenia.Teicoplanin showed the lowest incidence of thrombocytopenia,and its incidence of renal damage was significantly lower than vancomycin(RR=0.30,95%CI:0.10-0.92,P=0.04).Conclusion Linezolidis suggested to be the first choice for the treatment of MRSA pneumonia,and the optimal choice for MRSA pneumonia patients with renal insufficiency or low platelet count is teicoplanin.