Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr;32(2):65-70.
doi: 10.1177/8755122515610125. Epub 2015 Oct 9.

Meta-Analysis: Vancomycin Treatment Failures for MRSA Bacteremia Based on MIC Determined by E-test

Pramodini B Kale-Pradhan  1   2 , Nicholas P Mariani  3 , Sheila M Wilhelm  1   4 , Leonard B Johnson  1   2
Affiliations

Meta-Analysis: Vancomycin Treatment Failures for MRSA Bacteremia Based on MIC Determined by E-test

Pramodini B Kale-Pradhan et al. J Pharm Technol. 2016 Apr.

Abstract

Background: Vancomycin is used to treat serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA). It is unclear whether MRSA isolates with minimum inhibitory concentration (MIC) 1.5 to 2 µg/mL are successfully treated with vancomycin. Objective: Evaluate vancomycin failure rates in MRSA bacteremia with an MIC <1.5 versus ≥1.5 µg/mL, and MIC ≤1 versus ≥2 µg/mL. Methods: A literature search was conducted using MESH terms vancomycin, MRSA, bacteremia, MIC, treatment and vancomycin failure to identify human studies published in English. All studies of patients with MRSA bacteremia treated with vancomycin were included if they evaluated vancomycin failures, defined as mortality, and reported associated MICs determined by E-test. Study sample size, vancomycin failure rates, and corresponding MIC values were extracted and analyzed using RevMan 5.2.5. Results: Thirteen studies including 2955 patients met all criteria. Twelve studies including 2861 patients evaluated outcomes using an MIC cutoff of 1.5 µg/mL. A total of 413 of 1186 (34.8%) patients with an MIC <1.5 and 531 of 1675 (31.7%) patients with an MIC of ≥1.5 µg/mL experienced treatment failure (odds ratio = 0.72, 95% confidence interval = 0.49-1.04, P = .08). Six studies evaluated 728 patients using the cutoffs of ≤1 and ≥2 µg/mL. A total of 384 patients had isolates with MIC ≤1 µg/mL, 344 had an MIC ≥2 µg/mL. Therapeutic failure occurred in 87 and 102 patients, respectively (odds ratio = 0.61, 95% confidence interval = 0.34-1.10, P = .10). As heterogeneity between the studies was high, a random-effects model was used. Conclusion: Vancomycin MIC may not be an optimal sole indicator of vancomycin treatment failure in MRSA bacteremia.

Keywords: bacteremia; methicillin-resistant Staphylococcus aureus; minimum inhibitory concentration; treatment failure; vancomycin.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Search strategy. All search terms used were MESH terms.
Figure 2.
Figure 2.
Vancomycin treatment failure with MIC <1.5 or MIC ≥1.5.
Figure 3.
Figure 3.
Vancomycin treatment failure with MIC ≤1 or MIC ≥2.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18-e55. - PubMed
    1. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; Twenty-second informational supplement. http://antimicrobianos.com.ar/ATB/wp-content/uploads/2012/11/M100S22E.pdf. Published January 2012. Accessed June 15, 2015.
    1. Lodise TP, Graves J, Evans A, et al. Relationship between vancomycin MIC and failure among patients with methicillin-resistant Staphylococcus aureus bacteremia treated with vancomycin. Antimicrob Agents Chemother. 2008;52:3315-3320. - PMC - PubMed
    1. Soriano A, Marco F, Martinez JA, et al. Influence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis. 2008;46:193-200. - PubMed
    1. Jacob JT, DiazGranados CA. High vancomycin minimum inhibitory concentration and clinical outcomes in adults with methicillin-resistant Staphylococcus aureus infections: a meta-analysis. Int J Infect Dis. 2013;17:e93-e100. - PMC - PubMed