Effect of the vancomycin minimum inhibitory concentration on clinical outcomes in patients with methicillin-susceptible Staphylococcus aureus bacteraemia: a systematic review and meta-analysis

Objective The use of the vancomycin minimum inhibitory concentration (MIC) as a prognostic predictor in patients with methicillin-susceptible Staphylococcus aureus (MSSA) has been debated last decade. We performed systematic review and meta-analysis to investigate whether an elevated MIC is associated worse prognosis for MSSA bacteraemia. Design Systematic meta-analysis. Data sources PubMed, Embase Cochrane Library were searched from inception December 2019. Eligibility criteria Randomised controlled trials or observational studies considered eligible if they provided clinical outcomes bacteraemia, stratified by MIC. synthesis Primary outcome was mortality. Secondary included septic thrombophlebitis, persistent bacteraemia complicated Pooled ORs 95% CIs calculated. Subgroup analyses susceptibility testing method. Results Fifteen included. Bacteraemia due isolates high MICs higher mortality than low (OR 1.44; CI 1.12 1.84; I 2 =40.3%). Additionally, significantly greater thrombophlebitis 3.16; 1.11 9.00; =58.6%) trend towards more 1.79; 0.97 3.31; =0%) observed MICs. Differences not significant. Similar findings obtained subgroup using Etest. However, significant differences between detected broth microdilution. Conclusion available data suggest association Etest adverse Future should validate these explore potential mechanisms. PROSPERO registration number CRD42018090547.