Antibacterial drugs in treatment of methicillin-resistant staphylococcus aureus pneumonia:A network meta-analysis of 3 kinds of drugs

Objective To evaluate the efficacy and safety of 3 antibacterial drugs including vancomycin,linezolid and teicoplanin in treatment of methicillin-resistant staphylococcus aureus (MRSA) pneumonia. Methods Randomized controlled trials (RCTs) about vancomycin,linezolid and teicoplanin for the treatment of MRSA pneumonia were searched from ScienceDirect,MEDLINE,PubMed,the Cochrane Library,WanFang Data,CNKI,VIP Database and related references from initiation to September 15th 2019.The RCTs were screened according to the predefined inclusion and exclusion criteria,and the data were analyzed by Stata 15.0. Results Totally 25 RCTs published in Chinese or English involving 3367 patients were included.Network meta-analysis demonstrated that linezolid was significantly superior to vancomycin on effective rate (RR=1.22,95% CI:1.16-1.29,P=0.00),cure rate (RR=1.48,95% CI:1.28-1.71,P=0.00),and complete bacteria clearance rate (RR=1.22,95% CI:1.09-1.37,P=0.00).Probability ranking results showed that linezolid was the best and vancomycin was the worst in terms of 3 therapeutic indicators.There was no significant difference in the incidence of adverse reactions among the three drugs,but vancomycin had the highest incidence of renal damage,and linezolid had the highest incidence of thrombocytopenia.Teicoplanin showed the lowest incidence of thrombocytopenia,and its incidence of renal damage was significantly lower than vancomycin (RR=0.30,95% CI:0.10-0.92,P=0.04). Conclusion Linezolidis suggested to be the first choice for the treatment of MRSA pneumonia,and the optimal choice for MRSA pneumonia patients with renal insufficiency or low platelet count is teicoplanin.