Comparative effectiveness and safety of vancomycin versus linezolid for the treatment of central nervous system infections: a meta-analysis.

IF 4.8 2区医学 Q2 IMMUNOLOGY

Frontiers in Cellular and Infection Microbiology Pub Date : 2025-09-18 eCollection Date: 2025-01-01 DOI:10.3389/fcimb.2025.1668983

Liujun Zhou, Qihui Yao, Zecheng Wang, Lingyan Yu, Zhenwei Yu, Yuhua Zhao

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引用次数: 0

Abstract

Objectives: This study conducted a meta-analysis comparing vancomycin and linezolid for treating central nervous system (CNS) infections, addressing the lack of comprehensive evaluations in existing research on antibiotic therapy for CNS infections.

Methods: We systematically searched databases, including the PubMed, Embase, Web of Science, Cochrane Library and Chinese databases, up to April 22, 2025. All eligible randomized controlled trials and cohort studies of vancomycin or linezolid were included. The clinical success rate was the primary outcome of interest. The secondary outcomes of interest were cerebrospinal fluid (CSF) parameters, systemic inflammatory markers and the occurrence of adverse drug reactions (ADRs). Two reviewers independently extracted the data and assessed the study quality (NOS/ROB 2.0). The meta-analysis employed random/fixed-effects models to calculate pooled dichotomous outcomes (ORs) and continuous outcomes (SMDs) with 95% CIs via RevMan 5.4.

Results: This meta-analysis included 17 studies (6 head-to-head). Clinical cure rates were not significantly different between vancomycin (84.7%, 222/262) and linezolid (79.7%, 200/251), with a pooled OR of 1.29 (95% CI: 0.55-2.99; p =0.56), while substantial heterogeneity existed (I² = 58%). The secondary outcomes showed no differences but suffered extreme heterogeneity (I² >90%). Safety analysis revealed a significantly greater ADR with vancomycin (21.0% vs. 15.1%; OR 1.63, 95% CI: 1.01-2.65; p = 0.05) with low heterogeneity (I² = 15%).

Conclusion: Vancomycin and linezolid have similar effectiveness in CNS infection from current available evidences, but vancomycin is associated with a greater risk of ADR. Treatment selection should be based on patients' individual characteristics, such as risk of thrombocytopenia, renal function, and availability of therapeutic drug monitoring.

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万古霉素与利奈唑胺治疗中枢神经系统感染的有效性和安全性比较：一项荟萃分析。

目的：本研究对万古霉素和利奈唑胺治疗中枢神经系统（CNS）感染的疗效进行meta分析比较，解决现有抗生素治疗中枢神经系统感染研究中缺乏综合评价的问题。方法：系统检索截至2025年4月22日的PubMed、Embase、Web of Science、Cochrane Library和中文数据库。纳入万古霉素或利奈唑胺的所有符合条件的随机对照试验和队列研究。临床成功率是关注的主要结果。次要结局是脑脊液（CSF）参数、全身炎症标志物和药物不良反应（adr）的发生。两名审稿人独立提取数据并评估研究质量（NOS/ROB 2.0）。meta分析采用随机/固定效应模型，通过RevMan 5.4计算95% ci的合并二分类结局（ORs）和连续结局（SMDs）。结果：本荟萃分析包括17项研究（6项头对头）。万古霉素（84.7%,222/262）和利奈唑胺（79.7%,200/251）的临床治愈率无显著差异，合并OR为1.29 (95% CI: 0.55 ~ 2.99; p =0.56)，但存在显著异质性（I2 = 58%）。次要结局无差异，但存在极大的异质性（I²>90%）。安全性分析显示万古霉素的不良反应明显更大（21.0% vs. 15.1%; OR 1.63, 95% CI: 1.01-2.65; p = 0.05），异质性较低（I²= 15%）。结论：根据现有证据，万古霉素和利奈唑胺对中枢神经系统感染的疗效相似，但万古霉素与更大的不良反应风险相关。治疗选择应基于患者的个体特征，如血小板减少的风险、肾功能和治疗药物监测的可用性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Cellular and Infection Microbiology IMMUNOLOGY-MICROBIOLOGY

CiteScore

7.90

自引率

7.00%

发文量

1817

审稿时长

14 weeks

期刊介绍： Frontiers in Cellular and Infection Microbiology is a leading specialty journal, publishing rigorously peer-reviewed research across all pathogenic microorganisms and their interaction with their hosts. Chief Editor Yousef Abu Kwaik, University of Louisville is supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Cellular and Infection Microbiology includes research on bacteria, fungi, parasites, viruses, endosymbionts, prions and all microbial pathogens as well as the microbiota and its effect on health and disease in various hosts. The research approaches include molecular microbiology, cellular microbiology, gene regulation, proteomics, signal transduction, pathogenic evolution, genomics, structural biology, and virulence factors as well as model hosts. Areas of research to counteract infectious agents by the host include the host innate and adaptive immune responses as well as metabolic restrictions to various pathogenic microorganisms, vaccine design and development against various pathogenic microorganisms, and the mechanisms of antibiotic resistance and its countermeasures.