Comparative effectiveness and safety of six antibiotics in treating MRSA infections: A network meta-analysis

• Published in: International journal of infectious diseases 2024-09, Vol.146, p.107109, Article 107109
• Main Authors: Ju, Gehang, Zhang, Yan, Ye, Chao, Liu, Qiong, Sun, Hanzhu, Zhang, Zhaorui, Huang, Xinyi, Jiang, Yueping, Huang, Qi
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibiotics; Daptomycin - adverse effects; Daptomycin - therapeutic use; Effectiveness; Humans; Linezolid - adverse effects; Linezolid - therapeutic use; Methicillin-resistant Staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus - drug effects; Network Meta-Analysis; Randomized Controlled Trials as Topic; Safety; Soft Tissue Infections - drug therapy; Soft Tissue Infections - microbiology; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Teicoplanin - adverse effects; Teicoplanin - analogs & derivatives; Teicoplanin - therapeutic use; Tigecycline - adverse effects; Tigecycline - therapeutic use; Treatment Outcome; Vancomycin - adverse effects; Vancomycin - therapeutic use
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2024.107109

•Daptomycin excels in bloodstream infections, incl. endocarditis.•Vancomycin safer with fewer adverse reactions.•Linezolid outperforms in MRSA-related pneumonia, skin/soft tissue infections.•Linezolid linked to thrombocytopenia. This study conducted a network meta-analysis comparing linezolid, teicoplanin, daptomycin, tigecycline, and ceftaroline fosamil with vancomycin for treating MRSA-related diseases, addressing the lack of comprehensive evaluations in existing research on antibiotic therapy for MRSA infections. We systematically searched databases including PubMed, Embase, Web of Science, the Cochrane Librar up to August 22, 2023. All eligible randomized controlled trials of the six antibiotics were included in the NMA, and their effectiveness and safety were compared across various MRSA-related diseases. Categorical data were used for the odds ratio (OR), and continuous data were used for mean difference (SMD). The surface under the cumulative ranking (SUCRA) was employed to evaluate the incidence rate. According to SUCRA results, daptomycin was the most effective treatment (73.0%) in bloodstream infections. In pulmonary infections and skin and soft tissue infections, linezolid out-performed other antibiotics in effectiveness rate (90.6% and 86.3%), microbial killing rate (93.3% and 93.1%). Vancomycin showed lower adverse reactions than teicoplanin, with less hepatotoxicity compared to linezolid and tigecycline. Linezolid had higher thrombocytopenia risk but lower nephrotoxicity risk than others. Vancomycin was less effective in microbial killing rates than linezolid across various infections. The present research suggests that in pulmonary infections and skin and soft tissue infections, linezolid may be a better option for treating MRSA-related diseases. However, caution is warranted due to the association of linezolid with thrombocytopenia. Our study protocol was registered with the International Prospective Register of SystematicReviews (PROSPERO); Registration number: CRD42024535142.