Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Aug 20;2013(8):CD009726.
doi: 10.1002/14651858.CD009726.pub2.

Antibiotic therapy for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in surgical wounds

Kurinchi Selvan Gurusamy  1 , Rahul Koti, Clare D Toon, Peter Wilson, Brian R Davidson
Affiliations

Antibiotic therapy for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in surgical wounds

Kurinchi Selvan Gurusamy et al. Cochrane Database Syst Rev. .

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.

Objectives: To compare the benefits and harms of various antibiotic treatments in people with established surgical site infections (SSIs) caused by MRSA .

Search 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.

Selection criteria: 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.

Data collection and analysis: 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.

Main 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).

Authors' 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.

PubMed Disclaimer

Conflict of interest statement

Disclaimer

Department of Health disclaimer: the views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS (National Health Service), or the Department of Health.

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Linezolid versus vancomycin, Outcome 1 Eradication of MRSA.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Weigelt 2004 {published data only}
    1. Weigelt J, Kaafarani HM, Itani KM, Swanson RN. Linezolid eradicates MRSA better than vancomycin from surgical‐site infections. American Journal of Surgery 2004;188(6):760‐6. - PubMed

References to studies excluded from this review

Jacqueline 2011 {published data only}
    1. Jacqueline C, Amador G, Desessard C, Mabecque V, Miegeville AF, Caillon J, et al. Assessment of linezolid, vancomycin, and rifampicin as monotherapy in comparison with combination of linezolid/rifampicin and vancomycin/rifampicin in the treatment of methicillin‐resistant Staphylococcus aureus acute osteomyelitis. Clinical Microbiology and Infection 2011;17(Supplement S4):S428.
Lucasti 2008 {published data only}
    1. Lucasti C, Jasovich A, Umeh O, Jiang J, Kaniga K, Friedland I. Efficacy and tolerability of IV doripenem versus meropenem in adults with complicated intra‐abdominal infection: a phase III, prospective, multicenter, randomized, double‐blind, noninferiority study. Clinical Therapeutics 2008;30(5):868‐83. - PubMed
Philpott 2003 {published data only}
    1. Philpott‐Howard J, Burroughs A, Fisher N, Hastings M, Kibbler C, Mutimer D, et al. Piperacillin‐tazobactam versus ciprofloxacin plus amoxicillin in the treatment of infective episodes after liver transplantation. Journal of Antimicrobial Chemotherapy 2003;52:993‐1000. - PubMed
Van Laethem 1988 {published data only}
    1. Laethem Y, Hermans P, Wit S, Goosens H, Clumeck N. Teicoplanin compared with vancomycin in methicillin‐resistant Staphylococcus aureus infections: preliminary results. Journal of Antimicrobial Chemotherapy 1988;21(Supplement A):81‐7. - PubMed

Additional references

Barber 1961
    1. Barber M. Methicillin‐resistant staphylococci. Journal of Clinical Pathology 1961 Jul;14:385‐93. - PMC - PubMed
Chemaly 2010
    1. Chemaly RF, Hachem RY, Husni RN, Bahna B, Rjaili GA, Waked A, et al. Characteristics and outcomes of methicillin‐resistant Staphylococcus aureus surgical‐site infections in patients with cancer: a case‐control study. Annals of Surgical Oncology 2010;17(6):1499‐506. - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JPT, Altman DG, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group (Editors). Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
DeMets 1987
    1. DeMets DL. Methods for combining randomized clinical trials: strengths and limitations. Statistics in Medicine 1987;6(3):341‐50. - PubMed
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta‐analysis in clinical trials. Controlled Clinical Trials 1986;7(3):177‐88. - PubMed
Donlan 2002
    1. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clinical Microbiology Reviews 2002;15(2):167‐93. - PMC - PubMed
ECDC 2009a
    1. ECDC. European Centre for Disease Prevention and Control. Annual epidemiological report on communicable diseases in Europe. http://www.ecdc.europa.eu/en/publications/Publications/0910_SUR_Annual_E... 2009 (accessed on 17 June 2011). - PubMed
ECDC 2009b
    1. ECDC. European Centre for Disease Prevention and Control. The bacterial challenge: Time to react. A call to narrow the gap between multi‐drug resistant bacteria in the EU and the development of new anti‐bacterial agents. http://www.ecdc.europa.eu/en/publications/Publications/0909_TER_The_Bact... 2009 (accessed on 17 June 2011).
Egger 1997
    1. Egger M, Davey SG, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. - PMC - PubMed
Fraser 2010
    1. Fraser S, Brady R, Graham C, Paterson‐Brown S, Gibb A. Methicillin‐resistant Staphylococcus aureus in surgical patients: identification of high‐risk populations for the development of targeted screening programmes. Annals of the Royal College of Surgeons of England 2010;92(4):311‐5. - PMC - PubMed
Gurusamy 2009
    1. Gurusamy KS, Gluud C, Nikolova D, Davidson BR. Assessment of risk of bias in randomized clinical trials in surgery. British Journal of Surgery 2009;96(4):342‐9. - PubMed
Gurusamy 2013a
    1. Gurusamy KS, Koti R, Toon C, Wilson P, Davidson BR. Antibiotic therapy for the treatment of methicillin‐resistant Staphylococcus aureus (MRSA) in non‐surgical wounds. Cochrane Database of Systematic Reviews In press. - PMC - PubMed
Gurusamy 2013b
    1. Gurusamy KS, Koti R, Wilson P, Davidson BR. Antibiotic prophylaxis for the prevention of methicillin‐resistant Staphylococcus aureus (MRSA) related complications in surgical patients. Cochrane Database of Systematic Reviews In press. - PMC - PubMed
Harbarth 2008
    1. Harbarth S, Huttner B, Gervaz P, Fankhauser C, Chraiti MN, Schrenzel J, et al. Risk factors for methicillin‐resistant Staphylococcus aureus surgical site infection. Infection Control and Hospital Epidemiology 2008;29(9):890‐3. - PubMed
Higgins 2002
    1. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21(11):1539‐58. - PubMed
Higgins 2011a
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Higgins 2011b
    1. Higgins JPT, Altman DG, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group (Editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Higgins 2011c
    1. Higgins JPT, Deeks JJ and Altman DG on behalf of the Cochrane Statistical Methods Group (Editors). Chapter 16: Special topics in statistics. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Horan 1992
    1. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infection Control and Hospital Epidemiology 1992;13(10):606‐8. - PubMed
ICH‐GCP 1996
    1. International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use. Code of Federal Regulation & ICH Guidelines. Media: Parexel Barnett, 1996.
Jevons 1961
    1. Jevons PM. “Celbenin” ‐ resistant staphylococci. British Medical Journal 1961;1(5219):124‐5. - PMC - PubMed
Kallen 2010
    1. Kallen AJ, Mu Y, Bulens S, Reingold A, Petit S, Gershman K, et al. Health care‐associated invasive MRSA infections, 2005‐2008. JAMA 2010;304(6):641‐8. - PubMed
Kang 2012
    1. Kang CI, Song JH, Ko KS, Chung DR, Peck KR. Clinical features and outcomes of Staphylococcus aureus infections in non‐neutropenic cancer patients. Supportive Care in Cancer 2012;20(3):483‐8. - PubMed
Kaye 2008
    1. Kaye KS, Anderson DJ, Choi Y, Link K, Thacker P, Sexton DJ. The deadly toll of invasive methicillin‐resistant Staphylococcus aureus infection in community hospitals. Clinical Infectious Diseases 2008;46(10):1568‐77. - PubMed
Keel 2011
    1. Keel RA, Schaeftlein A, Kloft C, Pope JS, Knauft RF, Muhlebach M, et al. Pharmacokinetics of intravenous and oral linezolid in adults with cystic fibrosis. Antimicrobial Agents and Chemotherapy 2011;55(7):3393‐8. - PMC - PubMed
Kjaergard 2001
    1. Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta‐analyses. Annals of Internal Medicine 2001;135(11):982‐9. - PubMed
Klimek 1976
    1. Klimek JJ, Marsik FJ, Bartlett RC, Weir B, Shea P, Quintiliani R. Clinical, epidemiologic and bacteriologic observations of an outbreak of methicillin‐resistant Staphylococcus aureus at a large community hospital. American Journal of Medicine 1976;61(3):340‐5. - PubMed
Knox 1961
    1. Knox R, Smith JT. The nature of penicillin resistance in staphylococci. Lancet 1961;2(7201):520‐2. - PubMed
Kuehnert 2005
    1. Kuehnert MJ, Hill HA, Kupronis BA, Tokars JI, Solomon SL, Jernigan DB. Methicillin‐resistant–Staphylococcus aureus hospitalizations, United States. Emerging Infectious Diseases 2005;11(6):868‐72. - PMC - PubMed
Lamagni 2011
    1. Lamagni TL, Potz N, Powell D, Pebody R, Wilson J, Duckworth G. Mortality in patients with meticillin‐resistant Staphylococcus aureus bacteraemia, England 2004‐2005. Journal of Hospital Infection 2011;77(1):16‐20. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J, on behalf of the Cochrane Information Retrieval Methods Group. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Lewis 2011
    1. Lewis T, Chaudhry R, Nightingale P, Lambert P, Das I. Methicillin‐resistant Staphylococcus aureus bacteremia: epidemiology, outcome, and laboratory characteristics in a tertiary referral center in the UK. International Journal of Infectious Diseases 2011;15(2):e131‐5. - PubMed
Liu 2011
    1. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin‐resistant Staphylococcus aureus infections in adults and children: executive summary. Clinical Infectious Diseases 2011;52(3):285‐92. - PubMed
Loeb 2003
    1. Loeb MB, Main C, Eady A, Walkers‐Dilks C. Antimicrobial drugs for treating methicillin‐resistant Staphylococcus aureus colonization. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD003340] - DOI - PMC - PubMed
Macaskill 2001
    1. Macaskill P, Walter SD, Irwig L. A comparison of methods to detect publication bias in meta‐analysis. Statistics in Medicine 2001;20(4):641‐54. - PubMed
Melzer 2013
    1. Melzer M, Welch C. Outcomes in UK patients with hospital‐acquired bacteraemia and the risk of catheter‐associated urinary tract infections. Postgraduate Medical Journal 2013;Mar 21:Epub ahead of print. [DOI: 10.1136/postgradmedj-2012-131393] - DOI - PMC - PubMed
Moher 1998
    1. Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta‐analyses?. Lancet 1998;352(9128):609‐13. - PubMed
Newell 1992
    1. Newell DJ. Intention‐to‐treat analysis: implications for quantitative and qualitative research. International Journal of Epidemiology 1992;21(5):837‐41. - PubMed
O'Toole 1970
    1. O'Toole RD, Drew WL, Dahlgren BJ, Beaty HN. An outbreak of methicillin‐resistant Staphylococcus aureus infection. Observations in hospital and nursing home. JAMA 1970;213(2):257‐63. - PubMed
OED 2011
    1. OED. Oxford English Dictionary. The definitive record of the English language. http://www.oed.com/ 2011 (accessed on 7th April, 2011).
Otter 2011
    1. Otter JA, French GL. Community‐associated meticillin‐resistant Staphylococcus aureus strains as a cause of healthcare‐associated infection. Journal of Hospital Infection 2011;79(3):189‐93. - PubMed
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta‐analyses of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815‐34. - PubMed
Reddy 2007
    1. Reddy SL, Grayson AD, Smith G, Warwick R, Chalmers JA. Methicillin resistant Staphylococcus aureus infections following cardiac surgery: incidence, impact and identifying adverse outcome traits. European Journal of Cardio‐Thoracic Surgery 2007;32(1):113‐7. - PubMed
RevMan 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Ridgeway 2005
    1. Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R. Infection of the surgical site after arthroplasty of the hip. Journal of Bone and Joint Surgery. British Volume 2005;87(6):844‐50. - PubMed
Sanchez 2013
    1. Sanchez CJ Jr, Mende K, Beckius ML, Akers KS, Romano DR, Wenke JC, et al. Biofilm formation by clinical isolates and the implications in chronic infections. BMC Infectious Diseases 2013;13:47. - PMC - PubMed
Sanjay 2010
    1. Sanjay P, Fawzi A, Kulli C, Polignano FM, Tait IS. Impact of methicillin‐resistant Staphylococcus Aureus (MRSA) infection on patient outcome after pancreatoduodenectomy (PD)‐‐a cause for concern?. Pancreas 2010;39(8):1211‐4. - PubMed
Schulz 1995
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273(5):408‐12. - PubMed
Schunemann 2009
    1. Schunemann H, Brożek J, Oxman A, editors. Grade handbook for grading quality of evidence and strength of recommendation. Version 3.2 [updated March 2009]. The Grade Working Group, 2009. Available from http://www.Cc‐ims.Net/gradepro.
Schünemann 2011
    1. Schünemann HJ, Oxman AD, Higgins JPT, Vist GE, Glasziou P, Guyatt GH (editors) on behalf of the Cochrane Applicability and Recommendations Methods Group and the Cochrane Statistical Methods Group. Chapter 11: Presenting results and ‘Summary of findings’ tables. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Shukla 2009
    1. Shukla S, Nixon M, Acharya M, Korim MT, Pandey R. Incidence of MRSA surgical‐site infection in MRSA carriers in an orthopaedic trauma unit. Journal of Bone and Joint Surgery. British Volume 2009;91(2):225‐8. - PubMed
SIGN 2011
    1. Scottish Intercollegiate Guidelines Network (SIGN). Search filters. http://www.sign.ac.uk/methodology/filters.html#random 2011.
Skov 2005
    1. Skov R, Kolmos HJ, Peltonen R, Vuopio‐Varkila J, Hardardottir H, Gudlaugsson O, et al. MRSA infections increasing in the Nordic countries. Eurosurveillance 2005;10(31):http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2765.
Vinh 2009
    1. Vinh DC, Rubinstein E. Linezolid: a review of safety and tolerability. Journal of Infection 2009;59(Supplement 1):S59‐74. - PubMed
Wang 2010
    1. Wang JT, Wang JL, Fang CT, Chie WC, Lai MS, Lauderdale TL, et al. Risk factors for mortality of nosocomial methicillin‐resistant Staphylococcus aureus (MRSA) bloodstream infection: with investigation of the potential role of community‐associated MRSA strains. Journal of Infection 2010;61(6):449‐57. - PubMed
Watanabe 2008
    1. Watanabe A, Kohnoe S, Shimabukuro R, Yamanaka T, Iso Y, Baba H, et al. Risk factors associated with surgical site infection in upper and lower gastrointestinal surgery. Surgery Today 2008;38(5):404‐12. - PubMed
Wood 2008
    1. Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman GD, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta‐epidemiological study. BMJ 2008;336:601‐5. - PMC - PubMed
Wulf 2008
    1. Wulf M, Voss A. MRSA in livestock animals‐an epidemic waiting to happen?. Clinical Microbiology and Infection 2008;14(6):519‐21. - PubMed

Publication types

MeSH terms

LinkOut - more resources