title: Treatment of hospital-acquired pneumonia with linezolid or vancomycin: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Hospital-acquired pneumonia remains the most lethal and expensive nosocomial infection worldwide. Optimal therapy remains controversial. We aimed to compare mortality and clinical response outcomes in patients treated with either linezolid or vancomycin.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  PubMed, EMBASE, Cochrane Library, American College of Physicians Journal Club, Evidence-based Medicine BMJ and abstracts from infectious diseases and critical care meetings were searched through April 2013.
  
  
  METHODS
  All randomised clinical trials comparing linezolid to vancomycin for hospital-acquired pneumonia.
  
  
  METHODS
  Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. One author extracted the data and two authors rechecked and verified all data.
  
  
  RESULTS
  Nine randomised trials with a total of 4026 patients were included. The adjusted absolute mortality risk difference (RD) between linezolid and vancomycin was 0.01% (95% CI -2.1% to 2.1%; p=0.992; I(2)=13.5%. The adjusted absolute clinical response difference was 0.9% (95% CI -1.2% to 3.1%; p=0.409; I(2)=0%. The risk of both microbiological (RD=5.6%, 95% CI -2.2% to 13.3%; p=0.159; I(2)=0%) and methicillin-resistant Staphylococcus aureus (RD=6.4%, 95% CI -4.1% to 16.9%; p=0.230; I(2)=0%) eradication were not different between linezolid and vancomycin. Gastrointestinal side effects were more frequent with linezolid (RD=0.8% (95% CI 0% to 1.5%; p=0.05), but no differences were found with renal failure, thrombocytopenia and drug discontinuation due to adverse events. Our sample size provided 99.9% statistical power to detect differences between drugs regarding clinical response and mortality.
  
  
  CONCLUSIONS
  Linezolid and vancomycin have similar efficacy and safety profiles. The high statistical power and the near-zero efficacy difference between both antibiotics demonstrates that no drug is superior for the treatment of hospital-acquired pneumonia.
authors.affiliation: Infectious Diseases Division, Internal Medicine Department, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
authors.forename: Gleb
authors.initials: G
authors.lastname: Haynatzki
authors.forename: Mark E
authors.initials: ME
authors.lastname: Rupp
keywords: INTENSIVE & CRITICAL CARE