title: Comparative effectiveness of antibiotics for the treatment of MRSA complicated skin and soft tissue infections.
abstract: OBJECTIVE
  With a growing number of studies and comparators in MRSA skin infections, a unified framework for comparing treatments is needed for health technology assessment (HTA). The objective was to systematically assess the success rates of common antimicrobial agents for the treatment of complicated skin and soft tissue infections (cSSTIs) caused by MRSA.
  
  
  METHODS
  MEDLINE, EMBASE, and Cochrane databases were searched to identify published clinical trials in which dalbavancin, daptomycin, linezolid, telavancin, teicoplanin, tigecycline, and vancomycin were used to treat cSSTIs. Pooled efficacy estimates were generated from clinical and microbiological determinations of success for the MRSA-subgroups in cSSTI clinical trials using a Bayesian meta-analytic approach. Success rates for each antibiotic were reported with 95% Bayesian confidence intervals (called credible intervals [CrI]). In sensitivity analyses the impact of different model parameters and article quality were investigated.
  
  
  RESULTS
  Out of 36 identified studies, 14 studies on six antibiotics with 28 treatment arms (n = 1840) were included in the analysis. No MRSA data in cSSTI were found for teicoplanin. The pooled success rate and CrI(95%) for each agent was: vancomycin (74.7%; CrI(95%): 64.1%-83.5%), dalbavancin (87.7%; CrI(95%): 74.6%-95.4%), linezolid (84.4%; CrI(95%): 76.6%-90.6%), telavancin (83.5%; CrI(95%): 73.6%-90.8%), daptomycin (78.1%; CrI(95%): 54.6%-93.2%) and tigecycline (70.4%; CrI(95%): 48.0%-87.6%). Comparisons between antibiotics suggested differences versus vancomycin for linezolid (+9.7%; CrI(95%): 4.4%-15.8%), dalbavancin (+13.1%; CrI(95%): 1.0%-23.8%), and telavancin (+8.8%; CrI(95%): 1.5-16.7%). The finding of lower vancomycin efficacy in MRSA cSSTI did not change in sensitivity analyses.
  
  
  CONCLUSIONS
  The results of this meta-analysis suggest higher success rates for linezolid and the new glycopeptides (dalbavancin and telavancin) in MRSA-confirmed cSSTIs. The uncertainty margins reflect the study limitations including number of cases and indirect nature of the comparisons. This example of Bayesian meta-analysis for MRSA cSSTI provides a potential framework for comparisons that is useful for HTA and formulary decision-making.
authors.affiliation: Pharmerit Europe, Rotterdam, The Netherlands.
authors.forename: J Floris S
authors.initials: JF
authors.lastname: Logman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stephens
authors.forename: Bart
authors.initials: B
authors.lastname: Heeg
authors.forename: Seema
authors.initials: S
authors.lastname: Haider
authors.forename: Joseph
authors.initials: J
authors.lastname: Cappelleri
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
authors.forename: Alan
authors.initials: A
authors.lastname: Tice
authors.forename: Ben A
authors.initials: BA
authors.lastname: van Hout
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity; D008954:Models, Biological; D018461:Soft Tissue Infections / Q000188:drug therapy*; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013207:Staphylococcal Skin Infections / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents