Hassan Ishaq1, Wajeeha Tariq1, Khawaja Muhammad Talha1, Bharath Raj Varatharaj Palraj1, M Rizwan Sohail1,2,3, Larry M Baddour1,2, Maryam Mahmood4. 1. Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, USA. 2. Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. 3. Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA. 4. Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, USA. mahmood.maryam@mayo.edu.
Abstract
PURPOSE: To assess the relationship between high vancomycin minimum inhibitory concentrations (MIC), in patients with methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), and both mortality and complicated bacteremia. METHODS: Embase, Medline, EBM, Scopus and Web of Science were searched for studies published from January 1st 2014 to February 29th 2020. "High" vancomycin MIC cut off was defined as ≥ 1.5 mg/L. Three referees independently reviewed studies that compared outcomes in patients with MRSAB stratified by vancomycin MIC. Subgroup analyses were performed for rates of mortality and complicated bacteremia. RESULTS: A total of 13 studies with 2089 patients were included. Overall, mortality was 27.7% and 23.3% in the high and low vancomycin MIC group, respectively. No significant difference was found between vancomycin MIC groups for overall mortality, in-hospital mortality, late mortality, persistent bacteremia, severe sepsis or septic shock, acute renal failure, septic emboli or endocarditis, and osteomyelitis or septic arthritis. Early mortality was significantly associated with low vancomycin MIC. Mortality in studies using broth microdilution method (BMD) and need for mechanical ventilation were significantly associated with high vancomycin MIC. CONCLUSION: Overall mortality and complicated bacteremia were not significantly associated with high vancomycin MICs in a patient with MRSAB. Randomized controlled trials to assess the utility of vancomycin MIC values in predicting mortality and other adverse clinical outcomes are warranted.
PURPOSE: To assess the relationship between high vancomycin minimum inhibitory concentrations (MIC), in patients with methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), and both mortality and complicated bacteremia. METHODS: Embase, Medline, EBM, Scopus and Web of Science were searched for studies published from January 1st 2014 to February 29th 2020. "High" vancomycin MIC cut off was defined as ≥ 1.5 mg/L. Three referees independently reviewed studies that compared outcomes in patients with MRSAB stratified by vancomycin MIC. Subgroup analyses were performed for rates of mortality and complicated bacteremia. RESULTS: A total of 13 studies with 2089 patients were included. Overall, mortality was 27.7% and 23.3% in the high and low vancomycin MIC group, respectively. No significant difference was found between vancomycin MIC groups for overall mortality, in-hospital mortality, late mortality, persistent bacteremia, severe sepsis or septic shock, acute renal failure, septic emboli or endocarditis, and osteomyelitis or septic arthritis. Early mortality was significantly associated with low vancomycin MIC. Mortality in studies using broth microdilution method (BMD) and need for mechanical ventilation were significantly associated with high vancomycin MIC. CONCLUSION: Overall mortality and complicated bacteremia were not significantly associated with high vancomycin MICs in a patient with MRSAB. Randomized controlled trials to assess the utility of vancomycin MIC values in predicting mortality and other adverse clinical outcomes are warranted.
Authors: Natasha E Holmes; John D Turnidge; Wendy J Munckhof; James O Robinson; Tony M Korman; Matthew V N O'Sullivan; Tara L Anderson; Sally A Roberts; Wei Gao; Keryn J Christiansen; Geoffrey W Coombs; Paul D R Johnson; Benjamin P Howden Journal: J Infect Dis Date: 2011-08-01 Impact factor: 5.226
Authors: Ammar Habib; Muna Irfan; Larry M Baddour; Katherine Y Le; Nandan S Anavekar; Christine M Lohse; Paul A Friedman; David L Hayes; Walter R Wilson; James M Steckelberg; M Rizwan Sohail Journal: Europace Date: 2012-09-05 Impact factor: 5.214