Long-acting lipoglycopeptides compared to standard-of-care for the treatment of complicated gram-positive infections: A systematic review and meta-analysis.
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引用次数: 0
Abstract
Objectives: Long-acting lipoglycopeptides (LA-LGPs) are being used more frequently for the treatment of complicated Gram-positive infections, including osteomyelitis, prosthetic joint infections, bloodstream infections, and endocarditis. This systematic review and meta-analysis compared the efficacy and safety of LA-LGP to the standard of care (SOC) antibiotics for the treatment of these infections.
Methods: A systematic literature search was conducted using PubMed, Medline, Embase, Cochrane, and Clinicaltrials.gov through November 2024. Prospective and retrospective comparative studies evaluating patients being treated for complicated Gram-positive infections were included. Interventions included multi-dose LA-LGP, including dalbavancin and oritavancin, vs. SOC antibiotics. Risk of bias was assessed using Cochrane RoB 2 and ROBINS-I tools. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random effects model. The primary outcome was clinical success.
Results: Fourteen studies (n = 1582 patients) were included. Studies included a wide array of indications and dosing schemes. LA-LGP was associated with significantly higher clinical success rates compared to SOC (RR = 1.14, 95% CI = 1.05-1.23, P < 0.01). No significant differences were observed for infection recurrence, mortality, adverse events (AEs), or serious adverse events (SAEs). LA-LGP was associated with fewer hospital readmissions. A subgroup analysis of bone and joint infections showed no significant difference in clinical success between LA-LGP and SOC.
Conclusions: LA-LGP for the treatment of complicated Gram-positive infections resulted in similar efficacy and safety to SOC antibiotics and may be a reasonable alternative for such infections. Results should be interpreted with caution given the risk of bias and heterogeneity (PROSPERO Registration ID: CRD42024532465).
目的：长效脂糖肽（LA-LGP）越来越多地被用于治疗复杂的革兰氏阳性感染，包括骨髓炎、假体关节感染、血流感染和心内膜炎。本系统综述和荟萃分析比较了LA-LGP与标准护理（SOC）抗生素治疗这些感染的疗效和安全性。方法：通过PubMed、Medline、Embase、Cochrane和Clinicaltrials.gov进行系统文献检索，检索时间截止到2024年11月。前瞻性和回顾性比较研究评估了治疗复杂革兰氏阳性感染的患者。干预措施包括多剂量LA-LGP，包括达尔巴万星和奥利塔万星，与SOC抗生素。使用Cochrane RoB 2和ROBINS-I工具评估偏倚风险。采用随机效应模型计算合并风险比（RR）和95%置信区间（CI）。主要结果是临床成功。结果：纳入14项研究（n= 1582例患者）。研究包括广泛的适应症和给药方案。与SOC相比，LA-LGP具有更高的临床成功率（RR 1.14, 95% CI 1.05-1.23）。结论：LA-LGP治疗复杂革兰氏阳性感染的疗效和安全性与SOC抗生素相似，可能是这类感染的合理替代方案。考虑到偏倚和异质性的风险，对结果的解释应谨慎。（普洛斯彼罗注册ID: CRD42024532465）。
期刊介绍：
The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.
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