期刊
ANTIBIOTICS-BASEL
卷 10, 期 8, 页码 -出版社
MDPI
DOI: 10.3390/antibiotics10081014
关键词
daptomycin; vancomycin; MRSA; Staphylococcus aureus; bloodstream infection; endocarditis
资金
- [1627]
In the treatment of MRSA infections, daptomycin appears to be associated with a lower risk of clinical failure and treatment-limiting adverse events compared to vancomycin. Further studies are needed to better understand the differences between the two drugs.
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of invasive infections, mainly bloodstream infections (BSI) with or without endocarditis. The purpose of this meta-analysis was to compare vancomycin, the mainstay treatment, with daptomycin as therapeutic options in this context. Materials: PubMed, Embase and the Cochrane Database were searched from their inception to 15 February 2020. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, persistence of infection, length-of-stay, antibiotic discontinuation due to adverse events (AEs) and 30-day re-admission. This study was registered with PROSPERO, CRD42020169413. Results: Eight studies (1226 patients, 554 vs. 672 in daptomycin vs. vancomycin, respectively) were included. No significant difference in terms of overall mortality was observed [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.40-1.33, I-2 = 67%]. Daptomycin was associated with a significantly reduced risk of clinical failure (OR 0.58, 95% CI 0.38-0.89, I-2 = 60%), as confirmed by pooling adjusted effect sizes (adjusted OR against the use of vancomycin 1.94, 95%CI 1.33-1.82, I-2 = 41%), and was linked with fewer treatment-limiting AEs (OR 0.15, 95%CI 0.06-0.36, I-2 = 19%). No difference emerged between the two treatments as secondary outcomes. Results were not robust to unmeasured confounding (E-value lower than 95% CI 1.00 for all-cause mortality). Conclusions: Against MRSA BSI, with or without endocarditis, daptomycin seems to be associated with a lower risk of clinical failure and treatment-limiting AEs compared with vancomycin. Further studies are needed to better characterize the differences between the two drugs.
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