Abstract
This systematic review and meta-analysis of randomized controlled trials (RCTs) compared the clinical efficacy and safety of anti-MRSA cephalosporin and vancomycin-based treatment in treating acute bacterial skin and skin structure infections (ABSSSIs). PubMed, Embase, Cochrane Central Register of Controlled Trials, Turning Research into Practice, and ClinicalTrials.gov databases were searched for relevant articles from inception to 15 June 2020. RCTs comparing the clinical efficacy and safety of anti-MRSA cephalosporin with those of vancomycin-based regimens in treating adult patients with ABSSSIs were included. The primary and secondary outcomes were clinical response at the test-of-cure assessments and risk of adverse events (AEs), respectively. Eight RCTs were enrolled. The clinical response rate was not significantly different between anti-MRSA cephalosporin and vancomycin-based treatments (odds ratio [OR], 1.05; 95% CI, 0.90–1.23; I2 = 0%). Except for major cutaneous abscesses in which anti-MRSA cephalosporin-based treatment was associated with a lower clinical response rate than vancomycin-based treatment (OR, 0.62; 95% CI, 0.40–0.97; I2 = 0%), other subgroup analyses according to the type of cephalosporin (ceftaroline or ceftobiprole), type of infection, and different pathogens did not show significant differences in clinical response. Anti-MRSA cephalosporin-based treatment was only associated with a higher risk of nausea than vancomycin-based treatment (OR, 1.41; 95% CI, 1.07–1.85; I2 = 0%). In treating ABSSSIs, the clinical efficacy of anti-MRSA cephalosporin is comparable to that of vancomycin-based treatment, except in major cutaneous abscesses. In addition to nausea, anti-MRSA cephalosporin was as tolerable as vancomycin-based treatment.
Highlights
The incidence of acute bacterial skin and skin structure infections (ABSSSIs) is increasing in both community and hospital settings [1,2,3,4]
In vitro studies have shown that both ceftaroline and ceftobiprole exhibit potent in vitro activity against commonly encountered gram-positive bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA), penicillin-resistant Streptococcus pneumoniae, Enterococcus faecalis, and gram-negative pathogens such as Citrobacter spp., Escherichia coli, Enterobacter spp., Klebsiella spp., and Serratia spp. [13,14,15,16]
Most of the others were classified as having a low risk of bias, except for Claeys et al.’s study [17], which had a high risk of bias in selection, performance, and detection, and Noel et al ’s study [21], which had a high risk of bias in the attrition domain
Summary
The incidence of acute bacterial skin and skin structure infections (ABSSSIs) is increasing in both community and hospital settings [1,2,3,4]. In vitro studies have shown that both ceftaroline and ceftobiprole exhibit potent in vitro activity against commonly encountered gram-positive bacteria, including MRSA, penicillin-resistant Streptococcus pneumoniae, Enterococcus faecalis, and gram-negative pathogens such as Citrobacter spp., Escherichia coli, Enterobacter spp., Klebsiella spp., and Serratia spp. [13,14,15,16] These two anti-MRSA cephalosporins could be recommended as therapeutic options for ABSSSIs. Recently, several randomized controlled trials (RCTs) have reported the clinical efficacy and safety of ceftaroline and ceftobiprole in the treatment of ABSSSIs [17,18,19,20,21,22,23]. We conducted this systematic review and meta-analysis of RCTs to investigate the clinical efficacy and safety of the anti-MRSA cephalosporins, ceftaroline and ceftobiprole, for treating ABSSSIs, compared with vancomycin-based regimens
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