The Analysis Of MRSA Infection, Prevalence In Hospital And Comparison Of The Effectiveness And Safety Of Linezolid VS Vancomycin In The Treatment Of Mrsa-related Infection

Objective: Surveying the characteristics of patients with methicillin-resistant Staphylo-coccus aureus(MRSA) infection and drug resistance of MRSA in our hospital,in order to provide a basis for effective preservation measures of MRSA nosocomial infection.To compare the efficacy and safety of linezolid vs. vancomycin in the treatment of MRSA in our hospital.According to the existing domestic and international clinical research data,to evaluate the effectiveness and safety of linezolid versus vancomycin in MRSA-related infection using a meta-analysis of randomised controlled trials(RCTs).Methods:(1)Collected all non-repetition strains of MRSA from clinical in2011-2014,using the retrospective investigation methods to analyze the drug susceptibility results and clinical data of patients caused by MRSA,in order to master the prevalence of infection,clinic distribution and antibotics resistance.(2)Analysising the clinical records about patients with MRSA infection treated with linezolid(600 mg q12 h ivgtt or po)and with vancomycin(1g q 12 h ivgtt),all the treatment courses were7-14 days,then therapeutic efficiency,bacterial clearance and adverse effects of linezolid and vancomycin for MRSA infection were compared.(3)Comprehensive search Pubmed,Medline,Science Direct and CNKI,Wan Fang databases(Years were retrieved from building a database to September 2014) to determine RCTs data of linezolid and vancomycin treatment of MRSA-associated infections.Extract feature information included in the study,select the appropriate model to analyze the effects according to the heterogeneity test results, use funnel plot analysis publication bias.Results of the assessment included clinical cure, microbiological clearance rate,mortality and incidence of adverse reactions.Results:(1)A total of 414 non-repetition strains of MRSA were isolated from clinical samples within four years in our hospital,the separation rate was 46.10% in staphylococcus aureus,composition ratio of MRSA increased year by year, from 41.58% in 2011 rose to 51.67% in 2014,In various specimens, sputum was the highest(55.07%),followed by the pus(15.46%),discharge(14.49%).Male:female=1.3:1,>60 years old people accounted for the highest(38.49%) which is the vulnerable groups,MRSA infections were mainly respiratory,skin and soft tissue and incision infection,In different departments,brain surgery,ICU,respiratory,pediatrics,general surgery are the important infection departments.All MRSA strains were susceptible to vancomycin,tigecycline,quinupristin/dalfopristin and linezolid,Erythromycin, clindamycin,tetracycline showed high resistance rate over 73%, quinolones, rifampin,SMZ also have different degrees of resistance.Linezolid and vancomycin MIC ranges were maintained at 0.5-4μg / ml and ≤0.5-2μg/ml, did not drift.(2)34 cases were included in comparing linezolid group(n=13) with vancomycin group(n=21),Comparison results of linezolid group vs vancomycin group were as follows:effective rates:92.3% vs85.71%,MRSA eradication rates:61.54% vs 57.14%, adverse reactions rates:23.08% vs21.74%,there was not significant difference between two Groups, linezolid is equivalent to vancomycin in treating MRSA infections in our hospital.(3)Nine RCTs,involving 5657 patients,were included in the meta-analysis.Linezolid was associated with superior to vancomycin for clinical success at EOT(RR=1.86;95%CI:1.35-2.57;P=0.0002)and TOC(RR=1.10;95%CI:1.04-1.17;P=0.0004).Linezolid also showed clinical efficacy superior to vancomycin in the subgroup of pneumonia(RR=1.28;95%CI:1.09-1.50;P=0.003) or skin and soft-tissue infections(RR=1.06;95%CI:1.01-1.12;P=0.02), there was no difference in clinical success for patients with bacteraemia(P=0.97).Linezolid was associated with better MRSA eradication rates compared with vancomycin at EOT(RR=1.36;95%CI:1.14-1.63;P=0.0006)and TOC(RR=1.17;95%CI:1.04-1.31;P=0.008).There was no significant difference in all cause mortality between both groups(RR=0.98;95%CI:0.80-1.21;P=0.88).Although no difference was found regarding the overall incidence of drug-related adverse events(AEs)(RR=1.07;95%CI:0.96-1.19;P=0.25),but there were fewer Incidents of abnormal renalfunction(RR=0.42;95%CI:0.27-0.68;P=0.0001),rash(RR=0.33;95%CI:0.20-0.54;P <0.00001) in the linezolid group compared with vancomycin, however, more people reported gastrointestinal reactions(RR=2.58;95%CI:1.95-3.40;P<0.00001),when treated with linezolid.Thrombocytopenia was recorded more commonly in the linezolid group,but no statistical difference(RR=3.36;95%CI:0.71-15.83;P=0.12).The incidence of anemia in both groups(RR= 0.87;95%CI:0.65–1.17;P=0.37) equivalent.Conclusion:(1)The composition ratio of MRSA in staphylococcus aureus is rising within four years in our hospital,should be taken enough attention.The MRSA monitoring should be strengthened on key-department,the elder and patients with risk factors,in order to find infected patients and carriers in time,to adopt effective disinfection isolation measures to reduce the MRSA nosocomial outbreak.Using antibiotics drugs rationally to delay the occurrence of multi-drug resistance.(2)linezolid is equivalent to vancomycin in treating MRSA infections in our hospital,both can be used as a effective medication for MRSA infections.(3)Based on randomized controlled trials pooled data analysis,the efficacy of linezolid in the treatment of MRSA-associated infections should be better than vancomycin, but still need more well-designed,randomized, double-blind controlled trial of a large sample to further validate and support.