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

Abstract

Abstract A considerable number of researches compared the effectiveness and safety different antibiotics for a disease caused by MRSA. However, comprehensive evaluated antibiotic therapeutic different diseases caused by MRSA is lacking. The network meta-analysis (NMA) comprehensively compared the effectiveness and safety of linezolid, teicoplanin, daptomycin, and tigecycline with vancomycin in treating methicillin-resistant Staphylococcus aureus (MRSA)-caused diseases. PubMed, Embase, Web of Science, Cochrane Library, CNKI, and Wan-fang databases were searched for studies until Sep 28, 2021. All eligible randomized controlled trials of five antibiotics were included in the NMA, and their effectiveness and safety were compared in various MRSA-attributed diseases. The dichotomous variables adopted for the odds ratio (OR) and the surface under the cumulative ranking (SUCRA) to evaluate the incidence rate. The study was performed using Rev Man 5.4 and STATA 16.0 software. SUCRA analysis revealed the superiority of linezolid to other antibiotics in total effectiveness rate (98.9%), microbial killing rate (99.6%), and total nephrotoxicity (17.8%). Regarding safety, the total adverse reaction rate of vancomycin was inferior to teicoplanin (OR 0.49, 95% CI 0.30–0.80). Vancomycin total hepatotoxicity was inferior to linezolid (OR 0.36, 95% CI 0.18–0.73) and tigecycline (OR 0.15, 95% CI 0.03–0.66), and it was also inferior to linezolid (OR 0.33, 95% CI 0.24–0.47) and teicoplanin (OR 0.35, 95% CI 0.18–0.69) in total nephrotoxicity. Linezolid had a higher risk of thrombocytopenia than teicoplanin (OR 4.24, 95% CI 1.26–14.24) and vancomycin (OR 2.14, 95% CI 1.17–3.90). Moreover, linezolid exhibited higher effectiveness in pneumonia compared to vancomycin (OR 2.06, 95% CI 1.58–2.69) and teicoplanin (OR 1.67, 95% CI 1.06–2.62). For skin and soft-tissue infections, linezolid showed superior effectiveness to vancomycin (OR 1.62, 95% CI 1.20–2.18). Regarding the microbial killing rate, vancomycin was inferior to linezolid in pneumonia (OR 0.38, 95% CI 0.29–0.49), skin soft-tissue infection (OR 0.41, 95% CI 0.21–0.79), and other infections (OR 0.40, 95% CI 0.20–0.83). And teicoplanin was inferior to linezolid in treating pneumonia (OR 0.51, 95% CI 0.33–0.81) and other infections (OR 0.39, 95% CI 0.18–0.86). The present research suggest that linezolid may be a better option for treating MRSA-caused diseases. However, caution is warranted owing to linezolid-associated thrombocytopenia.