利奈唑胺與萬古霉素治療革蘭氏陽性菌血癥效果比較的系統評價_《中國循證醫學雜志》

作者：

岳冀蓉 , 房晨鸝 , 張雪梅 ,  董碧蓉

四川大學華西醫院干部醫療科（成都?610041）;

關鍵詞：

革蘭氏陽性菌血癥利奈唑胺萬古霉素隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20090117

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目的　比較利奈唑胺和萬古霉素治療革蘭氏陽性菌血癥的療效和安全性。
方法　計算機檢索Cochrane圖書館（2009年第1期）、Cochrane圖書館臨床對照試驗資料庫(2009年第1期)、MEDLINE、EMbase、Current Controlled Trials、The National Research Register、中國生物醫學文獻數據庫、中文科技期刊全文數據庫和中文學術期刊全文數據庫，手工檢索相關會議的中英文論文集。納入比較利奈唑胺和萬古霉素治療革蘭氏陽性菌血癥療效和安全性的隨機對照試驗（RCT），評價納入研究的內部真實性。檢索時間均從建庫至2009年3月10日，并采用RevMan 5.0進行Meta分析。
結果　共納入8個RCT，共670例患者。Meta分析結果顯示，利奈唑胺在治療革蘭氏陽性菌血癥方面與萬古霉素療效相當［RR= 1.07，95%CI（0.98，1.17），P= 0.15］。對于耐甲氧西林金葡菌引起的菌血癥，盡管利奈唑胺臨床治愈率略高于萬古霉素，但差異并無統計學意義［RR=1.22，95%CI（0.97，1.53），P=0.10］。在治療導管相關性菌血癥中，利奈唑胺與萬古霉素療效相當［RR=1.01，95%CI（0.86，1.19），P=0.90］。利奈唑胺和萬古霉素不良反應發生率無明顯差異（P=0.64），兩種藥物引起貧血的發生率也無明顯差異（P=0.48）。萬古霉素組發生腎功能不全的幾率為2.51%，明顯高于利奈唑胺組的0.47%（P=0.0003），而利奈唑胺引起血小板減少癥的幾率為4.39%，明顯高于萬古霉素組的1.35%（P=0.01）。
結論　目前的研究提示，利奈唑胺在治療革蘭氏陽性菌血癥方面的療效與萬古霉素相當。考慮到利奈唑胺較好的耐受性和較小的腎毒性，在治療萬古霉素耐藥患者、重癥患者，尤其合并腎功能不全時，可以考慮選用利奈唑胺替代萬古霉素進行治療。

引用本文： 岳冀蓉,房晨鸝,張雪梅,董碧蓉. 利奈唑胺與萬古霉素治療革蘭氏陽性菌血癥效果比較的系統評價. 中國循證醫學雜志, 2009, 09(6): 646-651. doi: 10.7507/1672-2531.20090117 復制

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10.	Jantausch BA, Deville J, Adler S, et al. Linezolid for the treatment of children with bacteremia or nosocomial pneumonia caused by resistant gram-positive bacterial pathogens. Pediatric Infectious Disease Journal, 2003, 22(9 Suppl): S164-S171.
11.	Kaplan SL, Afghani B, Lopez P, et al. Linezolid for the treatment of methicillin-resistant Staphylococcus aureus infections in children. Pediatric Infectious Disease Journal, 2003, 22(9 Suppl): S178-S185.
12.	Kaplan SL, Deville JG, Yogev R, et al. Linezolid versus vancomycin for treatment of resistant Gram-positive infections in children. Pediatric Infectious Disease Journal, 2003, 22(8): 677-686.
13.	Kohno S, Yamaguchi K, Aikawa N, et al. Linezolid versus vancomycin for the treatment of infections caused by methicillin-resistant Staphylococcus aureus in Japan. Journal of Antimicrobial Chemotherapy, 2007, 60(6): 1361-1369.
14.	Stevens DL, Herr D, Lampiris H, et al. Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clinical Infectious Diseases, 2002, 34(11): 1481-1490.
15.	Wilcox MH, Tack KJ, Bouza E, et al. Complicated skin and skin-structure infections and catheter-related bloodstream infections: noninferiority of linezolid in a phase 3 study. Clinical Infectious Diseases, 2009, 48(2): 203-212.
16.	Johnson LB, Almoujahed MO, Ilg K, et al. Staphylococcus aureus bacteremia: compliance with standard treatment, long-term outcome and predictors of relapse. Scand J Infect Dis, 2003, 35(11-12): 782-789.
17.	Chang FY, Peacock JE Jr, Musher DM, et al. Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Medicine (Baltimore), 2003, 82(5): 333-339.
18.	Moellering RC Jr. A novel antimicrobial agent joins the battle against resistant bacteria. Annals of Internal Medicine, 1999, 130(2): 155-157.
19.	Falagas ME, Siempos II, Vardakas KZ. Linezolid versus glycopeptide or (beta)-lactam for treatment of Gram-positive bacterial infections: meta-analysis of randomised controlled trials. The Lancet Infectious Diseases, 2008, 8(1): 53-66.
20.	Shorr AF, Kunkel MJ, Kollef M. Linezolid versus vancomycin for Staphylococcus aureus bacteraemia: Pooled analysis of randomized studies. Journal of Antimicrobial Chemotherapy, 2005, 56(5): 923-929.
21.	Yael W. waknine Off-Label use of Linezolid Linked to Increased Death Risk [EB/OL]. (2007-03-19). http://www.medscape.com/viewarticle/553803.

1. Abramson MA, Sexton DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol, 1999, 20(6): 408-411.
2. Chang S, Sievert DM, Hageman JC, et al. Infection with vancomycin-resistant Staphylococcus aureus containing vanA resistance gene. N Engl J Med, 2003, 348(14): 1342.
3. Fung HB, Kirschenbaum HL, Ojofeitimi BO. Linezolid: an oxazolidinone antimicrobial agent. Clinical Therapeutics, 2001, 23(3): 356-391.
4. Rubinstein E, Cammarata SK, Oliphant TH, et al. Linezolid (PNU-100766) versus vancomycin in the treatment of hospitalized patients with nosocomial pneumonia: a randomized, double-blind, multicenter study. Clin Infect Dis, 2001, 32(3): 402-412.
5. Kaplan SL, Patterson L, Edwards KM, et al. Linezolid for the treatment of community-acquired pneumonia in hospitalized children. Pediatr Infect Dis J, 2001, 20(3): 488-494.
6. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochranehandbook.org.
7. 吳泰相, 劉關鍵. 隱藏分組 (分配隱藏) 和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
8. Deville JG, Adler S, Azimi PH, et al. Linezolid versus vancomycin in the treatment of known or suspected resistant gram-positive infections in neonates. Pediatric Infectious Disease Journal, 2003, 22(9 Suppl): S158-S163.
9. Jaksic B, Martinelli G, Perez-Oteyza J, et al. Efficacy and safety of linezolid compared with vancomycin in a randomized, double-blind study of febrile neutropenic patients with cancer.[see comment]. Clinical Infectious Diseases, 2006, 42(5): 597-607.
10. Jantausch BA, Deville J, Adler S, et al. Linezolid for the treatment of children with bacteremia or nosocomial pneumonia caused by resistant gram-positive bacterial pathogens. Pediatric Infectious Disease Journal, 2003, 22(9 Suppl): S164-S171.
11. Kaplan SL, Afghani B, Lopez P, et al. Linezolid for the treatment of methicillin-resistant Staphylococcus aureus infections in children. Pediatric Infectious Disease Journal, 2003, 22(9 Suppl): S178-S185.
12. Kaplan SL, Deville JG, Yogev R, et al. Linezolid versus vancomycin for treatment of resistant Gram-positive infections in children. Pediatric Infectious Disease Journal, 2003, 22(8): 677-686.
13. Kohno S, Yamaguchi K, Aikawa N, et al. Linezolid versus vancomycin for the treatment of infections caused by methicillin-resistant Staphylococcus aureus in Japan. Journal of Antimicrobial Chemotherapy, 2007, 60(6): 1361-1369.
14. Stevens DL, Herr D, Lampiris H, et al. Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clinical Infectious Diseases, 2002, 34(11): 1481-1490.
15. Wilcox MH, Tack KJ, Bouza E, et al. Complicated skin and skin-structure infections and catheter-related bloodstream infections: noninferiority of linezolid in a phase 3 study. Clinical Infectious Diseases, 2009, 48(2): 203-212.
16. Johnson LB, Almoujahed MO, Ilg K, et al. Staphylococcus aureus bacteremia: compliance with standard treatment, long-term outcome and predictors of relapse. Scand J Infect Dis, 2003, 35(11-12): 782-789.
17. Chang FY, Peacock JE Jr, Musher DM, et al. Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Medicine (Baltimore), 2003, 82(5): 333-339.
18. Moellering RC Jr. A novel antimicrobial agent joins the battle against resistant bacteria. Annals of Internal Medicine, 1999, 130(2): 155-157.
19. Falagas ME, Siempos II, Vardakas KZ. Linezolid versus glycopeptide or (beta)-lactam for treatment of Gram-positive bacterial infections: meta-analysis of randomised controlled trials. The Lancet Infectious Diseases, 2008, 8(1): 53-66.
20. Shorr AF, Kunkel MJ, Kollef M. Linezolid versus vancomycin for Staphylococcus aureus bacteraemia: Pooled analysis of randomized studies. Journal of Antimicrobial Chemotherapy, 2005, 56(5): 923-929.
21. Yael W. waknine Off-Label use of Linezolid Linked to Increased Death Risk [EB/OL]. (2007-03-19). http://www.medscape.com/viewarticle/553803.

《中國循證醫學雜志》

利奈唑胺與萬古霉素治療革蘭氏陽性菌血癥效果比較的系統評價

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《中國循證醫學雜志》

利奈唑胺與萬古霉素治療革蘭氏陽性菌血癥效果比較的系統評價

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