Association between vancomycin minimum inhibitory concentration and mortality among patients with staphylococcus aureus bloodstream infections: A systematic review and meta-analysis

Research output: Chapter in Book/Report/Conference proceedingChapter

107 Citations (Scopus)

Abstract

DATA EXTRACTION AND SYNTHESIS: Two authors performed the literature search and the study selection separately. Random-effects modeling was used for all analyses.

MAIN OUTCOMES AND MEASURES All-cause mortality.

FINDINGS: Among 38 included studies that involved 8291 episodes of SAB, overall mortality was 26.1%. The estimated mortality was 26.8%among SAB episodes (n = 2740) in patients with high-vancomycin MIC (≥1.5mg/L) compared with 25.8%mortality among SAB episodes (n = 5551) in patients with low-vancomycin MIC (<1.5mg/L) (adjusted risk difference [RD], 1.6%[95%CI, -2.3%to 5.6%]; P = .43). For the highest-quality studies, the estimated mortality was 26.2%among SAB episodes (n = 2318) in patients with high-vancomycin MIC compared with 27.8%mortality among SAB episodes (n = 4168) in patients with low-vancomycin MIC (RD, 0.9%[95%CI, -2.9%to 4.6%]; P = .65). In studies that included only methicillin-resistant S aureus infections (n = 7232), the mortality among SAB episodes (n = 2384) in patients with high-vancomycin MIC was 27.6%compared with mortality of 27.4%among SAB episodes (n = 4848) in patients with low-vancomycin MIC (adjusted RD, 1.6%[95%CI, -2.3%to 5.5%]; P = .41). No significant differences in risk of death were observed in subgroups with high-vancomycin MIC vs low-vancomycin MIC values across different study designs, microbiological susceptibility assays, MIC cutoffs, clinical outcomes, duration of bacteremia, previous vancomycin exposure, and treatment with vancomycin.

CONCLUSIONS AND RELEVANCE: In this meta-analysis of SAB episodes, there were no statistically significant differences in the risk of death when comparing patients with S aureus exhibiting high-vancomycin MIC (≥1.5mg/L) to those with low-vancomycin MIC (<1.5mg/L), although the findings cannot definitely exclude an increased mortality risk. These findings should be considered when interpreting vancomycin susceptibility and in determining whether alternative antistaphylococcal agents are necessary for patients with SAB with elevated but susceptible vancomycin MIC values.

IMPORTANCE: Staphylococcus aureus bacteremia (SAB) is a worldwide problem. It is unclear whether higher-vancomycin minimum inhibitory concentration (MIC) is associated with mortality. This potential association has direct consequences for patients and public health.

DATA SOURCES PubMed, Embase, the Cochrane Library, Evidence-based Medicine BMJ, and the American College of Physicians Journal Club were searched from inception through April 2014.

STUDY SELECTION: Studies reporting mortality and vancomycin MIC in patients with SAB were included.

Original languageEnglish (US)
Title of host publicationJAMA - Journal of the American Medical Association
PublisherAmerican Medical Association
Pages1552-1564
Number of pages13
Volume312
Edition15
DOIs
StatePublished - Oct 15 2014

Fingerprint

Microbial Sensitivity Tests
Vancomycin
Staphylococcus aureus
Meta-Analysis
Bacteremia
Mortality
Infection
Methicillin Resistance
Evidence-Based Medicine
Proxy
PubMed
Libraries

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association between vancomycin minimum inhibitory concentration and mortality among patients with staphylococcus aureus bloodstream infections : A systematic review and meta-analysis. / Kalil, Andre C; VanSchooneveld, Trevor C; Fey, Paul D; Rupp, Mark Edmund.

JAMA - Journal of the American Medical Association. Vol. 312 15. ed. American Medical Association, 2014. p. 1552-1564.

Research output: Chapter in Book/Report/Conference proceedingChapter

@inbook{918d4baedec64e36a7f64eb0afeaa5fe,
title = "Association between vancomycin minimum inhibitory concentration and mortality among patients with staphylococcus aureus bloodstream infections: A systematic review and meta-analysis",
abstract = "DATA EXTRACTION AND SYNTHESIS: Two authors performed the literature search and the study selection separately. Random-effects modeling was used for all analyses.MAIN OUTCOMES AND MEASURES All-cause mortality.FINDINGS: Among 38 included studies that involved 8291 episodes of SAB, overall mortality was 26.1{\%}. The estimated mortality was 26.8{\%}among SAB episodes (n = 2740) in patients with high-vancomycin MIC (≥1.5mg/L) compared with 25.8{\%}mortality among SAB episodes (n = 5551) in patients with low-vancomycin MIC (<1.5mg/L) (adjusted risk difference [RD], 1.6{\%}[95{\%}CI, -2.3{\%}to 5.6{\%}]; P = .43). For the highest-quality studies, the estimated mortality was 26.2{\%}among SAB episodes (n = 2318) in patients with high-vancomycin MIC compared with 27.8{\%}mortality among SAB episodes (n = 4168) in patients with low-vancomycin MIC (RD, 0.9{\%}[95{\%}CI, -2.9{\%}to 4.6{\%}]; P = .65). In studies that included only methicillin-resistant S aureus infections (n = 7232), the mortality among SAB episodes (n = 2384) in patients with high-vancomycin MIC was 27.6{\%}compared with mortality of 27.4{\%}among SAB episodes (n = 4848) in patients with low-vancomycin MIC (adjusted RD, 1.6{\%}[95{\%}CI, -2.3{\%}to 5.5{\%}]; P = .41). No significant differences in risk of death were observed in subgroups with high-vancomycin MIC vs low-vancomycin MIC values across different study designs, microbiological susceptibility assays, MIC cutoffs, clinical outcomes, duration of bacteremia, previous vancomycin exposure, and treatment with vancomycin.CONCLUSIONS AND RELEVANCE: In this meta-analysis of SAB episodes, there were no statistically significant differences in the risk of death when comparing patients with S aureus exhibiting high-vancomycin MIC (≥1.5mg/L) to those with low-vancomycin MIC (<1.5mg/L), although the findings cannot definitely exclude an increased mortality risk. These findings should be considered when interpreting vancomycin susceptibility and in determining whether alternative antistaphylococcal agents are necessary for patients with SAB with elevated but susceptible vancomycin MIC values.IMPORTANCE: Staphylococcus aureus bacteremia (SAB) is a worldwide problem. It is unclear whether higher-vancomycin minimum inhibitory concentration (MIC) is associated with mortality. This potential association has direct consequences for patients and public health.DATA SOURCES PubMed, Embase, the Cochrane Library, Evidence-based Medicine BMJ, and the American College of Physicians Journal Club were searched from inception through April 2014.STUDY SELECTION: Studies reporting mortality and vancomycin MIC in patients with SAB were included.",
author = "Kalil, {Andre C} and VanSchooneveld, {Trevor C} and Fey, {Paul D} and Rupp, {Mark Edmund}",
year = "2014",
month = "10",
day = "15",
doi = "10.1001/jama.2014.6364",
language = "English (US)",
volume = "312",
pages = "1552--1564",
booktitle = "JAMA - Journal of the American Medical Association",
publisher = "American Medical Association",
edition = "15",

}

TY - CHAP

T1 - Association between vancomycin minimum inhibitory concentration and mortality among patients with staphylococcus aureus bloodstream infections

T2 - A systematic review and meta-analysis

AU - Kalil, Andre C

AU - VanSchooneveld, Trevor C

AU - Fey, Paul D

AU - Rupp, Mark Edmund

PY - 2014/10/15

Y1 - 2014/10/15

N2 - DATA EXTRACTION AND SYNTHESIS: Two authors performed the literature search and the study selection separately. Random-effects modeling was used for all analyses.MAIN OUTCOMES AND MEASURES All-cause mortality.FINDINGS: Among 38 included studies that involved 8291 episodes of SAB, overall mortality was 26.1%. The estimated mortality was 26.8%among SAB episodes (n = 2740) in patients with high-vancomycin MIC (≥1.5mg/L) compared with 25.8%mortality among SAB episodes (n = 5551) in patients with low-vancomycin MIC (<1.5mg/L) (adjusted risk difference [RD], 1.6%[95%CI, -2.3%to 5.6%]; P = .43). For the highest-quality studies, the estimated mortality was 26.2%among SAB episodes (n = 2318) in patients with high-vancomycin MIC compared with 27.8%mortality among SAB episodes (n = 4168) in patients with low-vancomycin MIC (RD, 0.9%[95%CI, -2.9%to 4.6%]; P = .65). In studies that included only methicillin-resistant S aureus infections (n = 7232), the mortality among SAB episodes (n = 2384) in patients with high-vancomycin MIC was 27.6%compared with mortality of 27.4%among SAB episodes (n = 4848) in patients with low-vancomycin MIC (adjusted RD, 1.6%[95%CI, -2.3%to 5.5%]; P = .41). No significant differences in risk of death were observed in subgroups with high-vancomycin MIC vs low-vancomycin MIC values across different study designs, microbiological susceptibility assays, MIC cutoffs, clinical outcomes, duration of bacteremia, previous vancomycin exposure, and treatment with vancomycin.CONCLUSIONS AND RELEVANCE: In this meta-analysis of SAB episodes, there were no statistically significant differences in the risk of death when comparing patients with S aureus exhibiting high-vancomycin MIC (≥1.5mg/L) to those with low-vancomycin MIC (<1.5mg/L), although the findings cannot definitely exclude an increased mortality risk. These findings should be considered when interpreting vancomycin susceptibility and in determining whether alternative antistaphylococcal agents are necessary for patients with SAB with elevated but susceptible vancomycin MIC values.IMPORTANCE: Staphylococcus aureus bacteremia (SAB) is a worldwide problem. It is unclear whether higher-vancomycin minimum inhibitory concentration (MIC) is associated with mortality. This potential association has direct consequences for patients and public health.DATA SOURCES PubMed, Embase, the Cochrane Library, Evidence-based Medicine BMJ, and the American College of Physicians Journal Club were searched from inception through April 2014.STUDY SELECTION: Studies reporting mortality and vancomycin MIC in patients with SAB were included.

AB - DATA EXTRACTION AND SYNTHESIS: Two authors performed the literature search and the study selection separately. Random-effects modeling was used for all analyses.MAIN OUTCOMES AND MEASURES All-cause mortality.FINDINGS: Among 38 included studies that involved 8291 episodes of SAB, overall mortality was 26.1%. The estimated mortality was 26.8%among SAB episodes (n = 2740) in patients with high-vancomycin MIC (≥1.5mg/L) compared with 25.8%mortality among SAB episodes (n = 5551) in patients with low-vancomycin MIC (<1.5mg/L) (adjusted risk difference [RD], 1.6%[95%CI, -2.3%to 5.6%]; P = .43). For the highest-quality studies, the estimated mortality was 26.2%among SAB episodes (n = 2318) in patients with high-vancomycin MIC compared with 27.8%mortality among SAB episodes (n = 4168) in patients with low-vancomycin MIC (RD, 0.9%[95%CI, -2.9%to 4.6%]; P = .65). In studies that included only methicillin-resistant S aureus infections (n = 7232), the mortality among SAB episodes (n = 2384) in patients with high-vancomycin MIC was 27.6%compared with mortality of 27.4%among SAB episodes (n = 4848) in patients with low-vancomycin MIC (adjusted RD, 1.6%[95%CI, -2.3%to 5.5%]; P = .41). No significant differences in risk of death were observed in subgroups with high-vancomycin MIC vs low-vancomycin MIC values across different study designs, microbiological susceptibility assays, MIC cutoffs, clinical outcomes, duration of bacteremia, previous vancomycin exposure, and treatment with vancomycin.CONCLUSIONS AND RELEVANCE: In this meta-analysis of SAB episodes, there were no statistically significant differences in the risk of death when comparing patients with S aureus exhibiting high-vancomycin MIC (≥1.5mg/L) to those with low-vancomycin MIC (<1.5mg/L), although the findings cannot definitely exclude an increased mortality risk. These findings should be considered when interpreting vancomycin susceptibility and in determining whether alternative antistaphylococcal agents are necessary for patients with SAB with elevated but susceptible vancomycin MIC values.IMPORTANCE: Staphylococcus aureus bacteremia (SAB) is a worldwide problem. It is unclear whether higher-vancomycin minimum inhibitory concentration (MIC) is associated with mortality. This potential association has direct consequences for patients and public health.DATA SOURCES PubMed, Embase, the Cochrane Library, Evidence-based Medicine BMJ, and the American College of Physicians Journal Club were searched from inception through April 2014.STUDY SELECTION: Studies reporting mortality and vancomycin MIC in patients with SAB were included.

UR - http://www.scopus.com/inward/record.url?scp=84908146651&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908146651&partnerID=8YFLogxK

U2 - 10.1001/jama.2014.6364

DO - 10.1001/jama.2014.6364

M3 - Chapter

C2 - 25321910

AN - SCOPUS:84908146651

VL - 312

SP - 1552

EP - 1564

BT - JAMA - Journal of the American Medical Association

PB - American Medical Association

ER -