Department of Microbiology and Infectious Diseases, Sydney South West Pathology Services-Liverpool, South Western Sydney Local Health Network, New South Wales, Sydney, Australia.
Clin Infect Dis. 2012 Mar;54(6):755-71. doi: 10.1093/cid/cir935. Epub 2012 Feb 2.
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.
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.
Of the 270 studies identified, 48 studies were reviewed, with 22 studies included in the final meta-analysis. 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 = .03) and isolates with a vancomycin MIC of 2 μg/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).
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.
新出现的数据表明，对于最低抑菌浓度（MIC）值处于较高范围的严重耐甲氧西林金黄色葡萄球菌（MRSA）感染，万古霉素的疗效可能较差。本研究旨在检验这些相关性的强度。
从 1996 年 1 月至 2011 年 8 月的医学文献中检索与万古霉素 MIC 相关的治疗结果或死亡率的所有相关研究，并根据 Cochrane 指南进行分析。
在确定的 270 项研究中，有 48 项研究进行了综述，其中 22 项研究纳入最终的荟萃分析。MRSA 感染的万古霉素 MIC 与死亡率显著相关，无论感染源或 MIC 方法如何（比值比 [OR]，1.64；95%置信区间 [CI]，1.14-2.37；P<.01）。这种死亡率相关性主要是由血流感染（BSI；OR，1.58；95%CI，1.06-2.37；P=.03）和 Etest 检测到的万古霉素 MIC 值为 2μg/mL 的分离株驱动（OR，1.72；95%CI，1.34-2.21；P<.01）。万古霉素 MIC 与治疗失败显著相关，无论感染源或 MIC 方法如何（OR，2.69；95%CI，1.60-4.51；P<.01）。
高万古霉素 MIC 与 MRSA BSI 的死亡率升高相关。因此，各机构应考虑对所有 MRSA BSI 分离株进行 Etest MIC 检测。尽管这些数据强调了对万古霉素的担忧，但目前没有数据支持替代抗生素可提高生存率。急需数据来确定其他药物是否可以改善万古霉素治疗 MIC 值升高的 MRSA 感染的这些结果。
