Comparative Nephrotoxicity and Efficacy of antibiotics for the treatment of Gram-Positive Bacterial Infections -- A systematic review and network meta-analysis
Date Issued
2012
Date
2012
Author(s)
Chang, Cheng-Yu
Abstract
Background：Bacterial resistance has risen dramatically during the last few decades and infections caused by Gram-positive organisms constituting nowadays the main cause of sepsis in in-hospital patients. In the United States, more than 60% of the Gram-positive organisms isolates in intensive care units are methicillin resistance Staphylococcus aureus now (MRSA). In Taiwan nosocomial surveillance system reports, the prevalence of MRSA in Gram-positive organisms is up to 80% in medical centers. There is uncertainty as to whether vancomycin in cause permanent or temporary kidney damage. Many studies have shown an increased risk of kidney failure after vancomycin treatment. At least five agents of antibiotics, including vancomycin, teicoplanin, linezolid, tigecycline and telavancin can against MRSA infection. The efficacies and nephrotoxicity of different antibiotics have been studies by traditional meta-analysis method. However, for clinical decisions, we need to know the safety and effective of each possible in comparison with all relevant alternatives, not just one. We conducted a network meta-analysis study of comparative nephrotoxicity and efficacy of antibiotics for the treatment of Gram-positive bacterial infections.
Method： We searched the Medline, Cochrane Library, PubMed databases to identify published clinical trials in which vancomycin, linezolid, telavancin, teicoplanin and tigecycline were used to treat Gram positive infection from January 1988 to December 2011. We also searched trials in “clnicaltrials.gov” which is a service of clinical trial registry in U.S. National institutes of Health. Among included articles, the following variables were abstracted and collected in a standardized form: authors; year of publication ; study design; gender; mean age; number of patients ; site of infection; antimicrobial agents and dosages used ; microorganism species and susceptibility; clinical cure outcome; microbiological eradication; survival; adverse events; and serious adverse events. The safety outcome is nephrotoxicity and efficacy outcomes are clinical cure and microbiological eradication. We analyzed direct and indirect comparisons of different treatments using Bayesian network meta-analysis.
Results：Literature searching and systematic review identified 390 non-duplicate citations, of which 26 trials comprising 8094 participants were included. In direct comparison, lower risk of nephrotoxicity in teicoplanin compared with vancomycin (OR: 0.37, 95% C.I: 0.19-0.70). There was no statistical difference in clinical cure between these antibiotic agents. In microbiological eradication, linezolid is significant more effective than vancomycin (OR: 1.29, 95%C.I: 1.02-1.63). In indirect comparison, telavancin was the antibiotics of most high risk nephrotoxicity than others, compare with teicoplanin (OR: 8.63, 95% credible interval (CrI): 2.26-66.47) and linezolid (OR: 6.88, 95%CrI: 1.50-58.15). The lower risk of nephrotoxicity with teicoplanin was observed. Compared with vancomycin, teicoplanin showed significant decrease the risk of nephrotoxicity (OR: 0.29, 95%CrI: 0.11-0.67). Linezolid was superior to vancomycin in clinical cure (OR: 1.4, 95%CrI: 1.01-1.93) and microbiological eradication (OR: 1.32, 95%CrI: 1.03-1.7).
Conclusion：Telavancin is associated with a greater risk of renal toxicity than other comparators. It is a novel concept in traditional and network meta-analysis study. Teicoplanin appear the lower risk of nephrotoxicity in treatment of Gram positive bacterial infection. Linezolid showed a significant superior efficacy in clinical cure and microbiological eradication than others. Better performed randomized trials on antibiotic treatment of Gram-positive infection are needed to build a more robust network meta-analysis.
Subjects
Gram-positive bacilli
methicillin-resistance Staphylococcus aureus (MRSA)
nephrotoxicity
clinical cure
microbiological eradication
network meta-analysis
Type
thesis
File(s)![Thumbnail Image]()
Loading...
Name
ntu-101-R99849034-1.pdf
Size
23.32 KB
Format
Adobe PDF
Checksum
(MD5):f74b9d776353436992fb7defa3d45be3