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耐药革兰氏阳性球菌的出现和传播已成为一个严重的临床问题。我们通过检索Pub Med,EMBASE,Elsevier数据库,纳入相关随机对照试验(RCT)。采用固定效应模型或随机效应模型对数据进行分析,计算风险比(RR)和95%置信区间。本文共纳入7个RCT研究,包括4个(2229例)复杂性皮肤软组织感染(c SSTIs)RCT研究,2个(1503例)医院获得性肺炎(HAP)RCT研究,1个(31例)金黄色葡萄球菌菌血症(SAB)RCT研究。Meta分析结果显示,对于c SSTIs,HAP,SAB,替拉万星与万古霉素或标准治疗方法相比,在意向治疗人群(RR 1.01,95%CI 0.97–1.05,P=0.72;FEM)及临床评估人群(RR 1.01,95%CI 0.98–1.04,P=0.41;FEM)中治愈率并无显著差异。然而,与万古霉素或标准治疗方法相比,替拉万星在耐甲氧西林金黄色葡萄球菌(MRSA)清除率方面具有显著优势(RR 1.08,95%CI 1.02–1.14,P=0.009;FEM)。替拉万星与与万古霉素或标准治疗方法相比,全因死亡率(9.0%vs.8.4%;RR 1.07,95%CI 0.88–1.31,P=0.49;FEM)及总体不良反应发生率(77.0%vs.72.3%;RR 1.08,95%CI 0.98–1.20,P=0.12;FEM)并无显著性差异;替拉万星与万古霉素或标准治疗方法相比,不良反应导致的患者退出发生率(7.7%vs.5.4%;RR 1.43,95%CI 1.12–1.83,P=0.05;FEM)和肌酐升高发生率(10.0%vs.5.1%;RR 1.95,95%CI 1.53–2.48,P<0.00001;FEM)较高,差异有统计学意义。因此,可以发现对于c SSTIs,HAP和SAB的治疗,替拉万星与万古霉素或标准治疗方法的治疗效果并无显著性差异,提示替拉万星可以作为万古霉素用于难治性MRSA感染的替代疗法。然而,替拉万星不良反应导致的患者退出发生率及肌酐升高发生率较高。
The emergence and spread of resistant Gram-positive cocci has become a serious clinical problem. We included the relevant randomized controlled trials (RCTs) by searching the Pub Med, EMBASE, Elsevier databases. Data were analyzed using a fixed-effects model or a random effects model to calculate the risk ratio (RR) and the 95% confidence interval. A total of seven RCTs were included in the study, including 4 (2229) RCTs of c SSTIs, 2 of 1503 hospital-acquired pneumonia (HAP) RCTs, 1 (31 patients) of gold Staphylococcus aureus bacteremia (SAB) RCT study. Meta-analysis showed that in intention-to-treat (RR 1.01, 95% CI 0.97-1.05, P = 0.72; FEM) and cetuximab treatment rates for c SSTIs, HAP, SAB, There was no significant difference in the cure rate in the clinically assessed population (RR 1.01, 95% CI 0.98-1.04, P = 0.41; FEM). However, telavancin was significantly superior to vancomycin or standard treatment in clearance of methicillin-resistant Staphylococcus aureus (MRSA) (RR 1.08, 95% CI 1.02-1.14, P = 0.009; FEM). Tiroflavan and all-cause mortality (9.0% vs. 8.4%; RR 1.07, 95% CI 0.88-1.31, P = 0.49; FEM) and overall adverse event rates compared with vancomycin or standard treatment (77.0% vs.72.3%; RR 1.08, 95% CI 0.98-1.20, P = 0.12; FEM); there was no significant difference in the response to telavancin compared with vancomycin or standard treatment The incidence of withdrawal (7.7% vs.5.4%; RR 1.43, 95% CI 1.12-1.83, P = 0.05; FEM) and the incidence of elevated creatinine (10.0% vs.5.1%; RR 1.95,95% CI 1.53-2.48 , P <0.00001; FEM) was higher, the difference was statistically significant. Thus, no significant difference in the therapeutic effect of tivastatine against vancomycin or standard treatment was observed for the treatment of c SSTIs, HAP and SAB, suggesting that tivaverine can be used as a refractory MRSA infection replacement therapy. However, the rate of withdrawal from patients and the increased incidence of creatinine due to telavancin adverse reactions is high.