The clinical significance of vancomycin minimum inhibitory concentration in Staphylococcus aureus infections: A systematic review and meta-analysis

Van Hal, S. J., Lodise, T. P. and Paterson, D. L. (2012) The clinical significance of vancomycin minimum inhibitory concentration in Staphylococcus aureus infections: A systematic review and meta-analysis. Clinical Infectious Diseases, 54 6: 755-771. doi:10.1093/cid/cir935


Author Van Hal, S. J.
Lodise, T. P.
Paterson, D. L.
Title The clinical significance of vancomycin minimum inhibitory concentration in Staphylococcus aureus infections: A systematic review and meta-analysis
Formatted title
The clinical significance of vancomycin minimum inhibitory concentration in Staphylococcus aureus infections: A systematic review and meta-analysis
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1537-6591
1058-4838
Publication date 2012-03-01
Year available 2012
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1093/cid/cir935
Open Access Status Not yet assessed
Volume 54
Issue 6
Start page 755
End page 771
Total pages 17
Place of publication Amsterdam, Netherlands
Publisher Elsevier
Language eng
Subject 2726 Microbiology (medical)
2725 Infectious Diseases
Abstract Background. Emerging data suggest that vancomycin may be less effective against serious methicillin-resistant Staphylococcus aureus (MRSA) infections with minimum inhibitory concentration (MIC) values at the higher end of the susceptibility range. The purpose of this review is to examine the strength of these associations.
Formatted abstract
      Background: Emerging data suggest that vancomycin may be less effective against serious methicillin-resistant Staphylococcus aureus (MRSA) infections with minimum inhibitory concentration (MIC) values at the higher end of the susceptibility range. The purpose of this review is to examine the strength of these associations.
     Methods: All relevant studies pertaining to treatment outcomes or mortality associated with vancomycin MIC were retrieved from the medical literature from January 1996 through August 2011 and analyzed according to Cochrane guidelines.
     Results: Of the 270 studies identified, 48 studies were reviewed, with 22 studies included in the final metaanalysis. Vancomycin MIC was significantly associated with mortality for MRSA infection irrespective of the source of infection or MIC methodology (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.14-2.37; P < .01). This mortality association was predominantly driven by bloodstream infections (BSIs; OR, 1.58; 95% CI, 1.06-2.37; P 5 .03) and isolates with a vancomycin MIC of 2 lg/mL by Etest (OR, 1.72; 95% CI, 1.34-2.21; P < .01). Vancomycin MIC was significantly associated with treatment failure irrespective of source of infection or MIC methodology (OR, 2.69; 95% CI, 1.60-4.51; P <.01).
     Conclusion: High vancomycin MIC was associated with a higher mortality rate in MRSA BSI. Thus, institutions should consider conducting Etest MICs on all MRSA BSI isolates. Although these data highlight concerns about vancomycin, currently, there are no data to support better survival rates with alternative antibiotics. Data are sorely needed to determine whether other agents can remedy these outcomes observed with vancomycin for MRSA infections with elevated vancomycin MIC values.
Keyword Risk-factors
Bactericidal activity
MRSA bacteremia
Resistant
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
Official 2013 Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 253 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 292 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 02 Apr 2012, 21:31:41 EST by System User on behalf of UQ Centre for Clinical Research