Efficacy of teicoplanin compared to Vancomycin : Systematic review of randomized clinical trials

Objective: To compare the efficacy of teicoplanin with that of vancomycin in patients with proven or suspected infection. Methods: We performed a systematic review and meta- analysis of published randomized controlled trials which compared teicoplanin with vancomycin. We searched Medline, Cochrane central, text books and previous meta- analyses. We extracted data by means of a standardized form. We used a random effect model to estimate the pooled risk ratio (RR) with 95% confidence interval (CI) as computed with MetaAnalyst free software. Results: We initially identified 166 potentially relevant studies. After exclusion of ineligible articles, the final data set consisted of 23 reports which had included 1851 patients. The random-effects model meta-analysis gave a relative effect of teicoplanin not significantly different from that of vancomycin (RR: 1.008; 95%CI: 0.972-1.045). We found no significant heterogeneity between the trials. We performed several sensitivity analyses, all of which provided similar results. Conclusions: Our analysis confirms the reports of those of previous meta- analyses that focused on other outcomes of the comparison of vancomycin and teicoplanin, but which reported summarized results of clinical efficacy. It can be confidently concluded that teicoplanin and vancomycin are equally effective.Objetivo: Comparar la eficacia de la vancomicina y la teicoplanina en pacientes con sospecha de infección o infección confirmada. Métodos: Fuente de datos: Realizamos una revisión sistemática y meta- análisis de ensayos clínicos randomizados que comparaban teicoplanina con vancomicina. Realizamos la búsqueda en Medline, Cochrane central, libros de texto y meta análisis previos. Extraíamos los datos con ayuda de un modelo estandarizado. Usamos un modelo de efectos aleatorios para estimar el riesgo relativo agregado (RR) con un intervalo de confianza (IC) del 95% realizado con el software MetaAnalist. Resultados: Se identificaron inicialmente 166 estudios potencialmente relevantes. Tras excluir los artículos inelegibles resultaron 23 artículos que incluían 1851 pacientes. El modelo de efectos aleatorios de meta- análisis concluyó un efecto relativo de la teicoplanina no significativamente diferente a la vancomicina (RR: 1.008; 95%CI: 0.972-1.045). No se halló heterogeneidad significativa entre ensayos. Se realizaron múltiples análisis de sensibilidad, que aportaron resultados similares. Conclusiones: Se confirman los resultados de meta análisis previos centrados en otros aspectos de la comparación entre vancomicina y teicoplanina. Se puede afirmar que la teicoplanina y vancomicina son igualmente efectivas.Grado en Medicin

Reproducibility of an artificial intelligence optical coherence tomography software for tissue characterization: Implications for the design of longitudinal studies.

BACKGROUND To assess the reproducibility of coronary tissue characterization by an Artificial Intelligence Optical Coherence Tomography software (OctPlus, Shanghai Pulse Medical Imaging Technology Inc.). METHODS 74 patients presenting with multivessel ST-segment elevation myocardial infarction (STEMI) underwent optical coherence tomography (OCT) of the infarct-related artery at the end of primary percutaneous coronary intervention (PPCI) and during staged PCI (SPCI) within 7 days thereafter in the MATRIX (Minimizing Adverse Hemorrhagic Events by Transradial Access Site and angioX) Treatment-Duration study (ClinicalTrials.gov, NCT01433627). OCT films were run through the OctPlus software. The same region of interest between either side of the stent and the first branch was identified on OCT films for each patient at PPCI and SPCI, thus generating 94 pairs of segments. 42 pairs of segments were re-analyzed for intra-software difference. Five plaque characteristics including cholesterol crystal, fibrous tissue, calcium, lipid, and macrophage content were analyzed for various parameters (span angle, thickness, and area). RESULTS There was no statistically significant inter-catheter (between PPCI and SPCI) or intra-software difference in the mean values of all the parameters. Inter-catheter correlation for area was best seen for calcification [intraclass correlation coefficient (ICC) 0.86], followed by fibrous tissue (ICC 0.87), lipid (ICC 0.62), and macrophage (ICC 0.43). Some of the inter-catheter relative differences for area measurements were large: calcification 9.75 %; cholesterol crystal 74.10 %; fibrous tissue 5.90 %; lipid 4.66 %; and macrophage 1.23 %. By the intra-software measurements, there was an excellent correlation (ICC > 0.9) for all tissue types. The relative differences for area measurements were: calcification 0.64 %; cholesterol crystal 5.34 %; fibrous tissue 0.19 %; lipid 1.07 %; and macrophage 0.60 %. Features of vulnerable plaque, minimum fibrous cap thickness and lipid area showed acceptable reproducibility. CONCLUSION The present study demonstrates an overall good reproducibility of tissue characterization by the Artificial Intelligence Optical Coherence Tomography software. In future longitudinal studies, investigators may use discretion in selecting the imaging endpoints and sample size, accounting for the observed relative differences in this study

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective