Int J Antimicrob Agents. 2023 Aug 3:106946. doi: 10.1016/j.ijantimicag.2023.106946. Online ahead of print.
OBJECTIVE: To evaluate the safety and efficacy of vancomycin with the other anti-Gram-positive bacteria antibiotics in the treatment of Staphylococcus aureus bacteremia.
METHOD: We searched the PubMed, Embase and the Cochrane Library databases until August 2022 for studies that compared vancomycin with other antibiotic regimens for treating Staphylococcus aureus bacteremia. Clinical and microbiological responses, adverse events, relapse rate and mortality, were considered.
RESULTS: 15 randomized controlled trials and 9 retrospective studies were included. The efficacy and safety data of vancomycin differed from those of the comparators group. After subgroup analysis, the differences mainly came from the trials compared with daptomycin. Compared to daptomycin, vancomycin showed a lower microbiological cure rate (OR=0.58, 95%CI=0.41∼0.82, I2=0%, P=0.002) and clinical cure rate (OR=0.53, 95%CI=0.42∼0.68, I2=3%, P<0.00001), as well as more adverse events (OR=3.21, 95%CI=1.43∼7.19, I2=59%, P=0.005).
CONCLUSION: The efficacy of vancomycin in treating S. aureus bacteremia is still excellent but slightly inferior in adverse events. However, this does not affect its use as a first-line drug. Daptomycin is expected to be a better antimicrobial drug.