Meta-analysis of vancomycin versus linezolid in pneumonia with proven methicillin-resistant Staphylococcus aureus.

Kato, Hideo; Hagihara, Mao; Asai, Nobuhiro; Shibata, Yuichi; Koizumi, Yusuke; Yamagishi, Yuka; Mikamo, Hiroshige

BACKGROUND American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines suggest that linezolid (LZD) is preferred over vancomycin (VCM) for treating methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. We conducted a systematic review and comparative meta-analysis of VCM and LZD efficacy against proven MRSA pneumonia. METHODS We searched EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed until November 2019. The outcomes of the meta-analysis were mortality, clinical cure, microbiological evaluation, and adverse events. RESULTS Seven randomized controlled trials (RCTs) with a total of 1,239 patients and eight retrospective cohort or case-control studies (CSs) with a total 6,125 patients were identified. Clinical cure and microbiological eradication rates were significantly increased in patients treated with LZD in RCTs (clinical cure: risk rate (RR) = 0.81, 95% confidential interval (CI) = 0.71-0.92, microbiological eradication: RR = 0.71, 95% CI = 0.62-0.81) and CSs (clinical cure: odds rate (OR) = 0.35, 95% CI = 0.18-0.69). However, mortality was comparable between patients treated with VCM and LZD in RCTs (RR = 1.08, 95% CI = 0.88-1.32) and CSs (OR = 1.20, 95% CI = 0.94-1.53). Likewise, there was no significant difference in adverse events between VCM and LZD in CSs (thrombocytopenia: OR = 0.95, 95% CI = 0.50-1.82, nephrotoxicity: OR = 1.72, 95% CI = 0.85-3.45). CONCLUSIONS According to our meta-analysis using RCTs and CSs conducted in worldwide, our findings would be one of robust evidences to corroborate the guidelines by IDSA for the treatment of proven MRSA pneumonia.