背景：本荟萃分析旨在评估联合治疗MSSA菌血症的有效性。
方法：我们搜索了OvidMEDLINE，EMBASE,科克伦中部,和clinicaltrials.gov用于研究，包括患有MSSA菌血症的成年人。单一疗法组使用抗MSSA活性的一线抗生素,并且组合组使用一线抗生素加额外的抗生素。主要结果是全因死亡率。次要结果包括持续性菌血症，菌血症的持续时间，复发,和不良事件。使用方差逆加权的随机效应模型来估计合并风险比(pRR)。使用I2值和Cochrane的Q统计量评估异质性。
结果：共纳入12项研究（6项随机对照试验[RCT]）。联合治疗不能显著降低30天死亡率(pRR0.92,95%CI,0.70-1.20),90天死亡率（pRR0.89，95%CI，0.74-1.06），或任何时间死亡率（pRR0.91，95%CI，0.76-1.08）。在深部感染患者中，利福平辅助治疗可降低90日死亡率(3项研究存在中度-高度偏倚风险;pRR0.62,95%CI,0.42~0.92).对于次要结果，联合治疗降低了复发风险(pRR0.38，95%CI，0.22-0.66)，但在合并RCTs时，这种益处未得到维持(pRR0.54，95%CI，0.12-2.51)。联合治疗与不良事件风险增加相关(pRR1.74,95%CI,1.31-2.31)。
结论：联合治疗不仅没有降低MSSA菌血症患者的死亡率，但也增加了不良事件的风险。联合治疗可以降低复发的风险，但需要更多高质量的研究.
BACKGROUND: This meta-analysis aims to evaluate the effectiveness of combination therapy for treating MSSA bacteremia.
METHODS: We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and clinicaltrials.gov for studies including adults with MSSA bacteremia. The monotherapy group used a first-line antibiotic active against MSSA and the combination group used a first-line antibiotic plus additional antibiotic/s. The primary outcome was all-cause mortality. Secondary outcomes included persistent bacteremia, duration of bacteremia, relapse, and adverse events. Random-effects models with inverse variance weighting were used to estimate pooled risk ratios (pRR). Heterogeneity was assessed using the I2 value and the Cochrane\'s Q statistic.
RESULTS: A total of 12 studies (6 randomized controlled trials [RCTs]) were included. Combination therapy did not significantly reduce 30-day mortality (pRR 0.92, 95% CI, 0.70-1.20), 90-day mortality (pRR 0.89, 95% CI, 0.74-1.06), or any-time mortality (pRR 0.91, 95% CI, 0.76-1.08). Among patients with deep-seated infections, adjunctive rifampicin may reduce 90-day mortality (3 studies with moderate-high risk of bias; pRR 0.62, 95% CI, 0.42-0.92). For secondary outcomes, combination therapy decreased the risk of relapse (pRR 0.38, 95% CI, 0.22-0.66), but this benefit was not maintained when pooling RCTs (pRR 0.54, 95% CI, 0.12-2.51). Combination therapy was associated with an increased risk of adverse events (pRR 1.74, 95% CI, 1.31-2.31).
CONCLUSIONS: Combination therapy not only did not decrease mortality in patients with MSSA bacteremia, but also increased the risk of adverse events. Combination therapy may reduce the risk of relapse, but additional high-quality studies are needed.
