title: Antibiotic therapy for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in surgical wounds.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) infection after surgery is usually rare, but incidence can be up to 33% in certain types of surgery. Postoperative MRSA infection can occur as surgical site infections (SSI), chest infections, or bloodstream infections (bacteraemia). The incidence of MRSA SSIs varies from 1% to 33% depending upon the type of surgery performed and the carrier status of the individuals concerned. The optimal antibiotic regimen for the treatment of MRSA in surgical wounds is not known.
  
  
  OBJECTIVE
  To compare the benefits and harms of various antibiotic treatments in people with established surgical site infections (SSIs) caused by MRSA .
  
  
  METHODS
  In February 2013 we searched the following databases: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Database of Abstracts of Reviews of Effects (DARE); NHS Economic Evaluation Database; Health Technology Assessment (HTA) Database; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL.
  
  
  METHODS
  We included only randomised controlled trials (RCTs) comparing one antibiotic regimen with another antibiotic regimen for the treatment of SSIs due to MRSA. All RCTs irrespective of language, publication status, publication year, or sample size were included in the analysis.
  
  
  METHODS
  Two review authors independently decided on inclusion and exclusion of trials, and extracted data. We planned to calculate the risk ratio (RR) with 95% confidence intervals (CI) for comparing the binary outcomes between the groups and mean difference (MD) with 95% CI for comparing the continuous outcomes. We planned to perform the meta-analysis using both a fixed-effect and a random-effects model. We performed intention-to-treat analysis whenever possible.
  
  
  RESULTS
  We included one trial involving 59 people hospitalised because of MRSA SSIs. Thirty participants were randomised to linezolid (600 mg either intravenously or orally every 12 hours for seven to 14 days) and 29 to vancomycin (1 g intravenously every 12 hours for seven to 14 days). The type of surgical procedures that were performed were not reported. The trial reported one outcome, which was the eradication of MRSA. The proportion of people in whom MRSA was eradicated was statistically significantly higher in the linezolid group than in the vancomycin group (RR 1.80; 95% CI 1.20 to 2.68).
  
  
  CONCLUSIONS
  There is currently no evidence to recommend any specific antibiotic in the treatment of MRSA SSIs. Linezolid is superior to vancomycin in the eradication of MRSA SSIs on the basis of evidence from one small trial that was at high risk of bias, but the overall clinical implications of using linezolid instead of vancomycin are not known. Further well-designed randomised clinical trials are necessary in this area.
authors: Department of Surgery, Royal Free Campus, UCL Medical School, Royal Free Hospital,, Rowland Hill Street, London, UK, NW3 2PF.
authors: Kurinchi Selvan
authors: KS
authors: Gurusamy
authors: Rahul
authors: R
authors: Koti
authors: Clare D
authors: CD
authors: Toon
authors: Peter
authors: P
authors: Wilson
authors: Brian R
authors: BR
authors: Davidson
mesh_terms: D000081:Acetamides / Q000627:therapeutic use; D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D000069349:Linezolid; D055624:Methicillin-Resistant Staphylococcus aureus; D023303:Oxazolidinones / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid
references: Stat Med. 2002 Jun 15;21(11):1539-58
references: 12111919
references: JAMA. 2010 Aug 11;304(6):641-8
references: 20699455
references: Stat Med. 2001 Feb 28;20(4):641-54
references: 11223905
references: Eur J Cardiothorac Surg. 2007 Jul;32(1):113-7
references: 17434315
references: JAMA. 1970 Jul 13;213(2):257-63
references: 5467891
references: Clin Microbiol Infect. 2008 Jun;14(6):519-21
references: 18325034
references: J Antimicrob Chemother. 2003 Dec;52(6):993-1000
references: 14585863
references: Int J Epidemiol. 1992 Oct;21(5):837-41
references: 1468842
references: J Antimicrob Chemother. 1988 Jan;21 Suppl A:81-7
references: 2965135
references: Br Med J. 1961 Jan 14;1(5219):113-4
references: 14447241
references: Ann Intern Med. 2001 Dec 4;135(11):982-9
references: 11730399
references: Ann Surg Oncol. 2010 Jun;17(6):1499-506
references: 20127184
references: Cochrane Database Syst Rev. 2013 Nov 18;(11):CD010427
references: 24242704
references: Control Clin Trials. 1986 Sep;7(3):177-88
references: 3802833
references: J Infect. 2010 Dec;61(6):449-57
references: 20875455
references: Lancet. 1961 Sep 2;2(7201):520-2
references: 13757232
references: J Hosp Infect. 2011 Jan;77(1):16-20
references: 21030112
references: Clin Infect Dis. 2008 May 15;46(10):1568-77
references: 18419491
references: Clin Infect Dis. 2011 Feb 1;52(3):285-92
references: 21217178
references: BMC Infect Dis. 2013 Jan 29;13:47
references: 23356488
references: Stat Med. 1987 Apr-May;6(3):341-50
references: 3616287
references: J Bone Joint Surg Br. 2005 Jun;87(6):844-50
references: 15911671
references: Euro Surveill. 2011 Nov 10;16(45):
references: 22114980
references: Clin Ther. 2008 May;30(5):868-83
references: 18555934
references: Cochrane Database Syst Rev. 2003;(4):CD003340
references: 14583969
references: Postgrad Med J. 2013 Jun;89(1052):329-34
references: 23520064
references: J Hosp Infect. 2011 Nov;79(3):189-93
references: 21741111
references: JAMA. 1995 Feb 1;273(5):408-12
references: 7823387
references: Int J Infect Dis. 2011 Feb;15(2):e131-5
references: 21134776
references: Emerg Infect Dis. 2005 Jun;11(6):868-72
references: 15963281
references: Infect Control Hosp Epidemiol. 1992 Oct;13(10):606-8
references: 1334988
references: J Bone Joint Surg Br. 2009 Feb;91(2):225-8
references: 19190058
references: Antimicrob Agents Chemother. 2011 Jul;55(7):3393-8
references: 21518837
references: BMJ. 1997 Sep 13;315(7109):629-34
references: 9310563
references: Pancreas. 2010 Nov;39(8):1211-4
references: 20944489
references: J Clin Pathol. 1961 Jul;14:385-93
references: 13686776
references: Am J Surg. 2004 Dec;188(6):760-6
references: 15619496
references: Ann R Coll Surg Engl. 2010 May;92(4):311-5
references: 20385046
references: Infect Control Hosp Epidemiol. 2008 Sep;29(9):890-3
references: 18785849
references: Br J Surg. 2009 Apr;96(4):342-9
references: 19283747
references: BMJ. 2008 Mar 15;336(7644):601-5
references: 18316340
references: Lancet. 1998 Aug 22;352(9128):609-13
references: 9746022
references: Cochrane Database Syst Rev. 2013 Aug 19;(8):CD010268
references: 23959704
references: Support Care Cancer. 2012 Mar;20(3):483-8
references: 21318576
references: Stat Med. 1998 Dec 30;17(24):2815-34
references: 9921604
references: J Infect. 2009 Sep;59 Suppl 1:S59-74
references: 19766891
references: Clin Microbiol Rev. 2002 Apr;15(2):167-93
references: 11932229
references: Surg Today. 2008;38(5):404-12
references: 18560962
references: Am J Med. 1976 Sep;61(3):340-5
references: 1048860