Vancomycin remains the most commonly used drug and standard of care for treatment of MRSA bacteremia. Studies suggest that alternative therapies for MRSA bacteremia are comparable to vancomycin with daptomycin and linezolid being the most commonly used alternate antibiotics. The objective of this meta-analysis was to evaluate the effectiveness of daptomycin and linezolid versus vancomycin for treatment of MRSA bacteremia.
Two investigators separately performed a literature search. PubMed, EMBASE and Cochrane library were searched for keywords: MRSA Bacteremia and Daptomycin, MRSA bacteremia and Linezolid, up until April 2015. Search was restricted to clinical trials in adult patients ≥18 years of age and published in English. For daptomycin, retrospective or prospective cohort studies that provided outcomes for mortality, persistent bacteremia and recurrence in MRSA bacteremia patients were included. For linezolid, studies that evaluated mortality and persistent bacteremia, as endpoints were included. Five daptomycin and three linezolid studies with a total of 823 subjects were included in analysis.
A total of 227 patients who received daptomycin were compared to 373 patients who received vancomycin. An overall statistically significant benefit was seen with daptomycin in terms of mortality (RR=0.441, CI 0.284-0.684, p=0.000) and persistent bacteremia (RR=0.680, CI 0.310-1.492, p=0.002). Although there was less recurrence of bacteremia (RR=0.853, CI 0.402-1.809, p=0.678) in those patients who were treated with daptomycin, statistical significance was not achieved.
Linezolid was prescribed to 81 patients while 142 received vancomycin. A mortality benefit (RR=0.273, CI 0.101-0.734, p=<0.01) with linezolid versus vancomycin was observed in 116 patients. Less persistence of bacteremia was also detected (RR=0.663, CI 0.159-2.767, p=0.573) in those receiving linezolid, however the difference did not reach statistical significance.
This analysis suggests statistically significant benefit in overall mortality with daptomycin and linezolid in treatment of MRSA bacteremia. In addition, daptomycin also showed significant reduction in persistent bacteremia.
L. Tamariz, None
L. Bush, CUBIST: Speaker's Bureau , Speaker honorarium