Association between high vancomycin minimum inhibitory concentration and clinical outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: a meta-analysis

Ishaq, Hassan; Tariq, Wajeeha; Talha, Khawaja M.; Palraj, Bharath Raj; Sohail, M. Rizwan; Baddour, Larry M.; Mahmood, Maryam

doi:10.1007/s15010-020-01568-4

Cited by 11 publications

(12 citation statements)

References 43 publications

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“…One of the possible explanations the authors propose for the lack of a significant association is the inclusion of those studies that include heteroresistant vancomycin-intermediate S. aureus (hVISA), a strain that is known to be less virulent. Some studies do show a clear association between high vancomycin MICs and infection recurrence [22,23]. In our cohort, a higher clinical failure rate was observed in cases with a vancomycin MIC ≥ 2.0 mg/L, but this finding was not statistically significant.…”

Section: Discussioncontrasting

confidence: 80%

“…There have been contradictory results as to whether the reduced susceptibility of staphylococci to vancomycin is associated with a worse outcome. A meta-analysis performed by Ishaq et al evaluating patients with methicillin-resistant S. aureus bacteraemia did not find a significant association between mortality or persistent bacteraemia and a higher vancomycin MIC in the susceptibility range (i.e., MIC ≥ 1.5 mg/L [22]. One of the possible explanations the authors propose for the lack of a significant association is the inclusion of those studies that include heteroresistant vancomycin-intermediate S. aureus (hVISA), a strain that is known to be less virulent.…”

Section: Discussionmentioning

confidence: 95%

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The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance

et al. 2022

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Introduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resistance patterns. We aimed to assess the antibiotic resistance patterns of S. epidermidis in early PJIs treated with surgical debridement and correlate them to clinical outcomes. Material and Methods: A retrospective multicentre observational study was conducted to evaluate patients with an early PJI (within 3 months after the index arthroplasty) by S. epidermidis with at least two positive intraoperative cultures. Clinical failure was defined as the need for additional surgical intervention or antibiotic suppressive therapy to control the infection. Results: A total of 157 patients were included. The highest rate of resistance was observed for methicillin in 82% and ciprofloxacin in 65% of the cases. Both were associated with a higher rate of clinical failure (41.2% vs. 12.5% (p 0.048) and 47.3% vs. 14.3% (p 0.015)), respectively. Furthermore, 70% of the cases had reduced susceptibility to vancomycin (MIC ≥ 2), which showed a trend towards a higher failure rate (39.6% vs. 19.0%, NS). Only 7% of the cases were rifampin-resistant. Only the resistance to fluoroquinolones was an independent risk factor for clinical failure in the multivariate analysis (OR 5.45, 95% CI 1.67–17.83). Conclusion: S. epidermidis PJIs show a high rate of resistance. Resistance to fluoroquinolones is associated with clinical failure. Alternative prophylactic antibiotic regimens and optimising treatment strategies are needed to improve clinical outcomes.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 95%

The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance

et al. 2022

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“…The same outcome was applicable to important microbiological predictors, such as the number of cases with MICs for VAN equal to 2 mg/L, that could not be analyzed separately as distinct subgroup. A recent meta-analysis [ 47 ] confirmed seminal results from Kalil and colleagues [ 48 ] in the context of MRSA BSI; high VAN MICs in the susceptible range of MRSA isolates (≥1.5 mg/L) did not augment the likelihood of overall mortality, though the possible confounding effect of more frequent prescription of combination antimicrobial therapy in this subgroup should not be overlooked.…”

Section: Discussionmentioning

confidence: 54%

Daptomycin versus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection with or without Endocarditis: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of invasive infections, mainly bloodstream infections (BSI) with or without endocarditis. The purpose of this meta-analysis was to compare vancomycin, the mainstay treatment, with daptomycin as therapeutic options in this context. Materials: PubMed, Embase and the Cochrane Database were searched from their inception to 15 February 2020. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, persistence of infection, length-of-stay, antibiotic discontinuation due to adverse events (AEs) and 30-day re-admission. This study was registered with PROSPERO, CRD42020169413. Results: Eight studies (1226 patients, 554 vs. 672 in daptomycin vs. vancomycin, respectively) were included. No significant difference in terms of overall mortality was observed [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.40–1.33, I2 = 67%]. Daptomycin was associated with a significantly reduced risk of clinical failure (OR 0.58, 95% CI 0.38–0.89, I2 = 60%), as confirmed by pooling adjusted effect sizes (adjusted OR against the use of vancomycin 1.94, 95%CI 1.33–1.82, I2 = 41%), and was linked with fewer treatment-limiting AEs (OR 0.15, 95%CI 0.06–0.36, I2 = 19%). No difference emerged between the two treatments as secondary outcomes. Results were not robust to unmeasured confounding (E-value lower than 95% CI 1.00 for all-cause mortality). Conclusions: Against MRSA BSI, with or without endocarditis, daptomycin seems to be associated with a lower risk of clinical failure and treatment-limiting AEs compared with vancomycin. Further studies are needed to better characterize the differences between the two drugs.

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“…Vancomycin is considered as the “last resort” for the treatment of severe infection caused by Gram-positive bacteria, 26 and it has an effective bactericidal ability against methicillin-resistant Staphylococcus aureus, the most common pathogen causing blood infections in hospitalized patients. 27 Nano-hydroxyapatite is the main component of bone minerals, which is biocompatible with the physiological environment, 28 and can stimulate macrophages to secrete angiogenesis and osteogenic growth factors. 29 This kind of drug-loaded microsphere composite scaffold can be used to repair infectious bone defects.…”

Section: Introductionmentioning

confidence: 99%

Dual-Nozzle 3D Printed Nano-Hydroxyapatite Scaffold Loaded with Vancomycin Sustained-Release Microspheres for Enhancing Bone Regeneration

Li¹,

Li²,

Du³

et al. 2023

IJN

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Background Successful treatment of infectious bone defect remains a major challenge in the orthopaedic field. At present, the conventional treatment for infectious bone defects is surgical debridement and long-term systemic antibiotic use. It is necessary to develop a new strategy to achieve effective bone regeneration and local anti-infection for infectious bone defects. Methods Firstly, vancomycin / poly (lactic acid-glycolic acid) sustained release microspheres (VAN/PLGA-MS) were prepared. Then, through the dual-nozzle 3D printing technology, VAN/PLGA-MS was uniformly loaded into the pores of nano-hydroxyapatite (n-HA) and polylactic acid (PLA) scaffolds printed in a certain proportion, and a composite scaffold (VAN/MS-PLA/n-HA) was designed, which can not only promote bone repair but also resist local infection. Finally, the performance of the composite scaffold was evaluated by in vivo and in vitro biological evaluation. Results The in vitro release test of microspheres showed that the release of VAN/PLGA-MS was relatively stable from the second day, and the average daily release concentration was about 15.75 μg/mL, which was higher than the minimum concentration specified in the guidelines. The bacteriostatic test in vitro showed that VAN/PLGA-MS had obvious inhibitory effect on Staphylococcus aureus ATCC-29213. Biological evaluation of VAN/MS-PLA/n-HA scaffolds in vitro showed that it can promote the proliferation of adipose stem cells. In vivo biological evaluation showed that VAN/MS-PLA/n-HA scaffold could significantly promote bone regeneration. Conclusion Our research shows that VAN/MS-PLA/n-HA scaffolds have satisfying biomechanical properties, effectively inhibit the growth of Staphylococcus aureus, with good biocompatibility, and effectiveness on repairing bone defects. The VAN/MS-PLA/n-HA scaffold provide the clinic with an application prospect in bone tissue engineering.

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Association between high vancomycin minimum inhibitory concentration and clinical outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: a meta-analysis

Cited by 11 publications

References 43 publications

The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance

The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance

Daptomycin versus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection with or without Endocarditis: A Systematic Review and Meta-Analysis

Dual-Nozzle 3D Printed Nano-Hydroxyapatite Scaffold Loaded with Vancomycin Sustained-Release Microspheres for Enhancing Bone Regeneration

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