PGY 李忠興 黃心慧 郭雅婷 戴維辰 葛宗昀 指導醫師：鍾福財醫師

Introduction Hospital-acquire pneumonia(HAP) – Most frequent type of infection in ICU – Mortality: 15-57% – Gram positive organisms, mainly Staphylococcus aureus, cause 1/3 of pneumonia

Introduction Optimal antibiotic therapy for HAP caused by GPC – Controversial – Two systematic review and meta-analyses comparing Linzolid and Glycopeptides(Vanco and Teico) Clinical cure and survival similar – New randonmised trials Linzolid is superior to Vancomycin – Important public health issue

Introduction Perceived difference of Linezolid and Vancomycin – Drive usage of one agent versus the other – Linezolid Increase risk of outbreaks of Linzolid resistant organisms Higher total cost Adverse drug events: Serotonin syndromes and Cytopenia – Vancomycin Increase risk of clinical failure if underdosed Increase risk of nephrotoxicity if overdosed

Introduction – The largest systemic review and meta-analysis Efficacy and Safety of linezolid versus vancomycin Cumulative number of 4026, allow close 100% statistical power to detect difference between 2 treatments Unlikely any future trial would add meaningful information Manufacturer does not plan to perform randomized trial with either drug

Method Literature search – April 2013 – Medline/Pubmed, EMBASE, Cochrane Library……. – Keyword: lizolid, oxazolidinioe, vancomycin, glycopeptide, Staphylococcus, Gram-positive, infections,randomised, prospective, lungs, respiratory, hospital-acquired, ventilator-associated, nosocomial pneumonia

Method Study selection – RCT Compare linezolid to vancomycin – Exclude: not Vancomycin, not containing original research Data extraction – Authors, publication year, study design, gender, mean age, sample size, site of infection, microorganism species and susceptibility, clinical response, microbiological eradication, mortality, adverse event

Method Efficacy and study outcome definitions – Primary efficacy outcomes Mortality, all-cause 28 day mortality Clinical response – Secondary efficacy outcomes Microbiological eradication MRSA eradication Safety – GI event, hepatitis, pancreatitis, renal failure, thrombocytopenia Statistical analysis