title: Linezolid versus vancomycin for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a systematic review employing meta-analysis.
abstract: OBJECTIVE
  The optimal therapy involving linezolid or vancomycin for suspected methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia (NP) remains controversial. This study compared the efficacy and safety of linezolid and vancomycin therapies in patients with NP.
  
  
  METHODS
  A systematic review of randomized controlled trials with meta-analyses performed by searching PubMed, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. We screened for relevant randomized controlled studies in which patients with NP were enrolled and linezolid and vancomycin therapies were compared.
  
  
  RESULTS
  Nine trials involving 2618 pneumonia patients were reviewed. Linezolid was not found to be superior to vancomycin for clinical cure when categories of pathogen were not considered and in a subgroup of NP patients with MRSA infection [relative risk (RR)=1.16, 95 % confidence interval (CI)=0.95-1.43, P=0.15]. Compared with vancomycin, linezolid has no difference in the overall microbiological eradication rate (RR=1.12, 95 % CI=0.96-1.30, P=0.15) and specific MRSA eradication rate (RR=1.16, 95 % CI=0.93-1.45, P=0.19) in NP patients. In addition, nephrotoxicity was more frequent with vancomycin (RR=0.50, 95 % CI=0.31-0.81, P=0.005), but no differences between the treatments were found for all-cause mortality, thrombocytopenia, gastrointestinal effects, and drug discontinuation due to adverse events.
  
  
  CONCLUSIONS
  These results suggest that linezolid is not superior to vancomycin with respect to both clinical and microbiological cure rates in patients with MRSA NP.
authors.affiliation: Department of Pharmacy, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, 710061, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Yamin
authors.initials: Y
authors.lastname: Zou
authors.forename: Jiao
authors.initials: J
authors.lastname: Xie
authors.forename: Taotao
authors.initials: T
authors.lastname: Wang
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Zheng
authors.forename: Hairong
authors.initials: H
authors.lastname: He
authors.forename: Weihua
authors.initials: W
authors.lastname: Dong
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Xing
authors.forename: Yalin
authors.initials: Y
authors.lastname: Dong
mesh_terms: D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy*; D006801:Humans; D000069349:Linezolid; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D023303:Oxazolidinones / Q000009:adverse effects / Q000627:therapeutic use*; D011014:Pneumonia / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D013203:Staphylococcal Infections / Q000188:drug therapy*; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid