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Comparative Efficacy and Safety of Linezolid and Quinupristin- Dalfopristin in the Treatment of Vancomycin-Resistant Enterococcus Infections: A Meta-Analysis

Tomoki Watanabe, Rika Uchida, Satoko Handa, Manabu Shindo, Ichiro Kato and Yasuhisa Kato

Introduction: Vancomycin-resistant Enterococcus (VRE) is one of the most important causative organisms of nosocomial infections. Once VRE outbreaks occur in hospitals, enormous efforts must be made to control them, especially in wards housing neutropenic or transplant patients. The purpose of this meta-analysis was to investigate the efficacy and adverse event profile of linezolid versus that of Quinupristin-Dalfopristin for the treatment of VRE infections.

Methodology: Literature searches of PubMed, MEDLINE, and EMBASE databases were performed on April 5, 2017 using combined text words with the following MeSH/EMTREE terms: “linezolid” and “Quinupristin-Dalfopristin” and “Enterococcus” and “human.” The odds ratios (ORs) with 95% confidence intervals (CIs) for individual studies were calculated and pooled separately. The pooled estimates were combined using the inverse variance weighting scheme and random effect method.

Results: A systematic search identified 674 articles, and five involving 333 patients were included in the final analysis. One study was a prospective randomized controlled trial, and four were retrospective studies. The mortality rate in the groups of patients treated with linezolid was significantly lower than that in patients treated with Quinupristin-Dalfopristin (OR: 0.47; 95% CI: 0.23 to 0.97; heterogeneity P=0.13, Z=2.05, P=0.04; I2=44%; Begg’s test: P=0.33; Egger’s test: P=0.78). The clinical and microbiological responses indicated no significant differences between the linezolid and Quinupristin- Dalfopristin groups (58% and 43%, respectively, P=0.6; OR: 1.51; 95% CI: 0.75 to 3.04; heterogeneity P=0.32; Z=1.15, P=0.25; I2=0%). The adverse event proiles differed between the Linezolid and quinupristin-dalfopristin groups.

Conclusion: Our results suggest a significantly lower mortality rate in patients treated with linezolid than in those treated with Quinupristin-Dalfopristin for VRE infections; however, this was limited by a variety of factors (mostly retrospective).