利奈唑胺和糖肽类抗生素对复杂性皮肤及软组织感染治疗效果的荟萃分析  

Linezolid versus glycopeptides in the treatment of complicated skin and soft tissue infections:a meta-analysis of randomized controlled trials

作　　者：郭志峰[1] 林志青[1] 黄萍[1] 陈琪[1] 

机构地区：[1]厦门大学附属中山医院儿科,福建厦门361004

出　　处：《中国感染与化疗杂志》2011年第4期268-275,共8页Chinese Journal of Infection and Chemotherapy

摘　　要：目的对现已发表的利奈唑胺和糖肽类抗生素治疗革兰阳性球菌复杂性皮肤及软组织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糖肽类抗生素。方法计算机检索Medline数据库、Embase数据库、Ovid数据库、Co-chrane图书馆及中文生物医学期刊数据库等网络资源,并查阅所有纳入的参考文献,进行荟萃分析。纳入用英文或中文发表的、比较利奈唑胺和糖肽类抗生素治疗革兰阳性球菌复杂性皮肤及软组织感染疗效的随机对照试验。采用χ2检验鉴定研究间异质性,使用随机效应或固定效应模型合并研究。采用敏感性分析方法探讨试验结果的稳定性。结果共纳入9个随机对照试验,包括3 248例革兰阳性球菌复杂性皮肤及软组织感染患者。分析结果显示,在临床可评估患者中,利奈唑胺治疗结束后[OR 1.92,95%CI(1.18,3.14),P=0.009]及随访结束后[OR 1.59,95%CI(1.24,2.05),P=0.000 3]的临床治愈率优于糖肽类抗生素;而在意向性分析集患者中,利奈唑胺随访结束后[OR 1.37,95%CI(0.98,1.92),P=0.07]的临床治愈率相当于糖肽类抗生素;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 1.57,95%CI(1.18,2.10),P=0.002]、金葡菌清除率[OR=2.34,95%CI(1.63,3.37),P<0.000 01]、MRSA清除率[OR=2.27,95%CI(1.20,4.31),P=0.01]方面,利奈唑胺亦优于糖肽类抗生素,而在链球菌清除率[OR=1.17,95%CI(0.23,5.97),P=0.85]及肠球菌清除率[OR=6.43,95%CI(0.23,181.82),P=0.28]方面,利奈唑胺与糖肽类抗生素相仿。结论在治疗革兰阳性球菌复杂性皮肤及软组织感染中,利奈唑胺疗效优于糖肽类抗生素。Objective A meta-analysis of randomized controlled trials was conducted to evaluate the efficacy and safety of linezolid versus glycopeptides in patients with complicated skin and soft tissue infections caused by gram-positive coccus.Methods The data were retrieved from the MEDLINE,EMBASE,OVID databases,the Cochrane library,and Chinese Biomedical Database.The references cited by eligible studies were manually screened.Randomized controlled trials published in English and Chinese comparing linezolid with glycopeptides in patients with complicated skin and soft tissue infections caused by gram-positive coccus were eligible for inclusion.Heterogeneity was examined by Chi-square test.Fixed effects model or random effects model was used to pool the data.Sensitivity analyses were conducted to verify the robustness of the results.Results Nine randomized controlled studies comparing linezolid with glycopeptides were analyzed,including 3 248 patients with complicated skin and soft tissue infections caused by gram-positive cocci.Meta-analysis showed that linezolid was more effective than glycopeptides in clinically evaluable patients in terms of clinical treatment success at the end-of-treatment visit [OR 1.92,95% CI（1.18,3.14）,P=0.009] and at the test-of-cure visit [OR 1.59,95% CI（1.24,2.05）,P=0.000 3].However,there was no difference in intention-to-treat patients at the test-of-cure visit [OR 1.37,95% CI（0.98,1.92）,P=0.07].With respect to microbiological treatment success,linezolid was more effective than glycopeptides in microbiologically evaluable patients at the test-of-cure visit [OR 1.57,95% CI（1.18,2.10）,P=0.002].Additionally,empirical treatment with linezolid was associated with higher eradication rates for S.aureus [OR=2.34,95% CI（1.63,3.37）,P0.000 01] and MRSA strains [OR=2.27,95% CI（1.20,4.31）,P=0.01] than glycopeptides in microbiologically evaluable patients at the test-of-cure visit.There was no difference between linezolid and glycopeptides in eradication rates for streptococcal speci

关 键 词：利奈唑胺 糖肽类抗生素 革兰阳性球菌 复杂性皮肤及软组织感染 荟萃分析 

分 类 号：R753[医药卫生—皮肤病学与性病学]