Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Respiratory Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
BMJ Open. 2021 Jan 15;11(1):e040675. doi: 10.1136/bmjopen-2020-040675.
The use of the vancomycin minimum inhibitory concentration (MIC) as a prognostic predictor in patients with methicillin-susceptible (MSSA) has been debated in the last decade. We performed a systematic review and meta-analysis to investigate whether an elevated vancomycin MIC is associated with a worse prognosis for patients with MSSA bacteraemia.
Systematic review and meta-analysis.
PubMed, Embase and the Cochrane Library were searched from inception to December 2019.
Randomised controlled trials or observational studies were considered eligible if they provided clinical outcomes of patients with MSSA bacteraemia, stratified by vancomycin MIC.
Primary outcome was mortality. Secondary outcomes included septic thrombophlebitis, persistent bacteraemia and complicated bacteraemia. Pooled ORs and 95% CIs were calculated. Subgroup analyses included the susceptibility testing method.
Fifteen observational studies were included. Bacteraemia due to MSSA isolates with high vancomycin MICs was associated with higher mortality than isolates with low MICs (OR 1.44; 95% CI 1.12 to 1.84; I=40.3%). Additionally, significantly greater septic thrombophlebitis (OR 3.16; 95% CI 1.11 to 9.00; I=58.6%) and a trend towards more persistent bacteraemia (OR 1.79; 95% CI 0.97 to 3.31; I=0%) were observed in patients with high vancomycin MICs than in patients with low MICs. Differences in complicated bacteraemia were not significant. Similar findings were obtained in subgroup analyses using Etest. However, significant differences in outcomes were not observed between the high and low vancomycin MICs detected using broth microdilution.
The available data suggest an association between elevated vancomycin MICs detected using Etest and adverse clinical outcomes for patients with MSSA bacteraemia. Future studies should validate these findings and explore the potential mechanisms.
CRD42018090547.
在耐甲氧西林金黄色葡萄球菌（MSSA）患者中，万古霉素最低抑菌浓度（MIC）作为预后预测因子的使用在过去十年中一直存在争议。我们进行了系统评价和荟萃分析，以调查万古霉素 MIC 升高是否与 MSSA 菌血症患者的预后较差相关。
系统评价和荟萃分析。
2019 年 12 月前，从 PubMed、Embase 和 Cochrane 图书馆中检索到了数据。
如果研究提供了 MSSA 菌血症患者的临床结局，并按万古霉素 MIC 进行分层，则认为随机对照试验或观察性研究是合格的。
主要结局是死亡率。次要结局包括脓毒性血栓性静脉炎、持续性菌血症和复杂性菌血症。计算了合并的 OR 和 95%置信区间。亚组分析包括药敏试验方法。
共纳入 15 项观察性研究。万古霉素 MIC 值较高的 MSSA 分离株引起的菌血症与 MIC 值较低的分离株相比，死亡率更高（OR 1.44；95%CI 1.12 至 1.84；I=40.3%）。此外，在万古霉素 MIC 值较高的患者中，观察到显著更高的脓毒性血栓性静脉炎（OR 3.16；95%CI 1.11 至 9.00；I=58.6%）和持续性菌血症的趋势（OR 1.79；95%CI 0.97 至 3.31；I=0%），而在 MIC 值较低的患者中则没有观察到差异。复杂性菌血症的差异无统计学意义。采用 Etest 进行的亚组分析也得到了类似的结果。然而，采用肉汤微量稀释法检测到的高和低万古霉素 MIC 之间的临床结局没有显著差异。
现有数据表明，Etest 检测到的万古霉素 MIC 升高与 MSSA 菌血症患者的不良临床结局之间存在关联。未来的研究应该验证这些发现，并探讨潜在的机制。
PROSPERO 注册号：CRD42018090547。
