Treatment of hospital-acquired pneumonia with linezolid or vancomycin: A systematic review and meta-analysis

Research output: Contribution to journalArticle

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Abstract

Objective: Hospital-acquired pneumonia remains the most lethal and expensive nosocomial infection worldwide. Optimal therapy remains controversial. We aimed to compare mortality and clinical response outcomes in patients treated with either linezolid or vancomycin. Design: Systematic review and meta-analysis. Data sources: PubMed, EMBASE, Cochrane Library, American College of Physicians Journal Club, Evidence-based Medicine BMJ and abstracts from infectious diseases and critical care meetings were searched through April 2013. Eligibility criteria for selecting studies: All randomised clinical trials comparing linezolid to vancomycin for hospital-acquired pneumonia. Data extraction: Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. One author extracted the data and two authors rechecked and verified all data. Results: Nine randomised trials with a total of 4026 patients were included. The adjusted absolute mortality risk difference (RD) between linezolid and vancomycin was 0.01% (95% CI -2.1% to 2.1%; p=0.992; I2=13.5%. The adjusted absolute clinical response difference was 0.9% (95% CI -1.2% to 3.1%; p=0.409; I2=0%. The risk of both microbiological (RD=5.6%, 95% CI -2.2% to 13.3%; p=0.159; I2=0%) and methicillin-resistant Staphylococcus aureus (RD=6.4%, 95% CI -4.1% to 16.9%; p=0.230; I2=0%) eradication were not different between linezolid and vancomycin. Gastrointestinal side effects were more frequent with linezolid (RD=0.8% (95% CI 0% to 1.5%; p=0.05), but no differences were found with renal failure, thrombocytopenia and drug discontinuation due to adverse events. Our sample size provided 99.9% statistical power to detect differences between drugs regarding clinical response and mortality. Conclusions: Linezolid and vancomycin have similar efficacy and safety profiles. The high statistical power and the near-zero efficacy difference between both antibiotics demonstrates that no drug is superior for the treatment of hospital-acquired pneumonia.

Original languageEnglish (US)
Article numbere003912
JournalBMJ open
Volume3
Issue number10
DOIs
StatePublished - Nov 4 2013

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Linezolid
Vancomycin
Meta-Analysis
Pneumonia
Mortality
Therapeutics
Pharmaceutical Preparations
Information Storage and Retrieval
Evidence-Based Medicine
Critical Care
Methicillin-Resistant Staphylococcus aureus
Cross Infection
PubMed
Thrombocytopenia
Sample Size
Libraries
Renal Insufficiency
Communicable Diseases
Randomized Controlled Trials

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Treatment of hospital-acquired pneumonia with linezolid or vancomycin : A systematic review and meta-analysis. / Kalil, Andre C; Klompas, Michael; Haynatzki, Gleb; Rupp, Mark Edmund.

In: BMJ open, Vol. 3, No. 10, e003912, 04.11.2013.

Research output: Contribution to journalArticle

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abstract = "Objective: Hospital-acquired pneumonia remains the most lethal and expensive nosocomial infection worldwide. Optimal therapy remains controversial. We aimed to compare mortality and clinical response outcomes in patients treated with either linezolid or vancomycin. Design: Systematic review and meta-analysis. Data sources: PubMed, EMBASE, Cochrane Library, American College of Physicians Journal Club, Evidence-based Medicine BMJ and abstracts from infectious diseases and critical care meetings were searched through April 2013. Eligibility criteria for selecting studies: All randomised clinical trials comparing linezolid to vancomycin for hospital-acquired pneumonia. Data extraction: Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. One author extracted the data and two authors rechecked and verified all data. Results: Nine randomised trials with a total of 4026 patients were included. The adjusted absolute mortality risk difference (RD) between linezolid and vancomycin was 0.01{\%} (95{\%} CI -2.1{\%} to 2.1{\%}; p=0.992; I2=13.5{\%}. The adjusted absolute clinical response difference was 0.9{\%} (95{\%} CI -1.2{\%} to 3.1{\%}; p=0.409; I2=0{\%}. The risk of both microbiological (RD=5.6{\%}, 95{\%} CI -2.2{\%} to 13.3{\%}; p=0.159; I2=0{\%}) and methicillin-resistant Staphylococcus aureus (RD=6.4{\%}, 95{\%} CI -4.1{\%} to 16.9{\%}; p=0.230; I2=0{\%}) eradication were not different between linezolid and vancomycin. Gastrointestinal side effects were more frequent with linezolid (RD=0.8{\%} (95{\%} CI 0{\%} to 1.5{\%}; p=0.05), but no differences were found with renal failure, thrombocytopenia and drug discontinuation due to adverse events. Our sample size provided 99.9{\%} statistical power to detect differences between drugs regarding clinical response and mortality. Conclusions: Linezolid and vancomycin have similar efficacy and safety profiles. The high statistical power and the near-zero efficacy difference between both antibiotics demonstrates that no drug is superior for the treatment of hospital-acquired pneumonia.",
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AU - Rupp, Mark Edmund

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N2 - Objective: Hospital-acquired pneumonia remains the most lethal and expensive nosocomial infection worldwide. Optimal therapy remains controversial. We aimed to compare mortality and clinical response outcomes in patients treated with either linezolid or vancomycin. Design: Systematic review and meta-analysis. Data sources: PubMed, EMBASE, Cochrane Library, American College of Physicians Journal Club, Evidence-based Medicine BMJ and abstracts from infectious diseases and critical care meetings were searched through April 2013. Eligibility criteria for selecting studies: All randomised clinical trials comparing linezolid to vancomycin for hospital-acquired pneumonia. Data extraction: Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. One author extracted the data and two authors rechecked and verified all data. Results: Nine randomised trials with a total of 4026 patients were included. The adjusted absolute mortality risk difference (RD) between linezolid and vancomycin was 0.01% (95% CI -2.1% to 2.1%; p=0.992; I2=13.5%. The adjusted absolute clinical response difference was 0.9% (95% CI -1.2% to 3.1%; p=0.409; I2=0%. The risk of both microbiological (RD=5.6%, 95% CI -2.2% to 13.3%; p=0.159; I2=0%) and methicillin-resistant Staphylococcus aureus (RD=6.4%, 95% CI -4.1% to 16.9%; p=0.230; I2=0%) eradication were not different between linezolid and vancomycin. Gastrointestinal side effects were more frequent with linezolid (RD=0.8% (95% CI 0% to 1.5%; p=0.05), but no differences were found with renal failure, thrombocytopenia and drug discontinuation due to adverse events. Our sample size provided 99.9% statistical power to detect differences between drugs regarding clinical response and mortality. Conclusions: Linezolid and vancomycin have similar efficacy and safety profiles. The high statistical power and the near-zero efficacy difference between both antibiotics demonstrates that no drug is superior for the treatment of hospital-acquired pneumonia.

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