Monday February 18, 2008
Vancomycin worse for MSSA ?

Vancomycin is widely used for empirical treatment of patients with suspected gram-positive bacteremia, even if its not MRSA. One Recent large case-control study from korea showed poorer outcomes for vancomycin than for β-lactams in patients with methicillin-susceptible (MSSA) bacteremia.

In a retrospective cohort study (n=294), patients who received vancomycin or teicoplanin therapy had a significantly higher S. aureus related mortality rate than did those with -lactam treatment.

Results:

• In cohort study, S. Aureus Bateremia (SAB)-related mortality in patients with vancomycin treatment (37%, 10/27) was significantly higher than that in those with beta-lactam treatment (18%, 47/267) (P=0.02)
• In the case-control study using the objective matching scoring system and the propensity score system, SAB-related mortality in case patients was 37% (10/27) and in control patients 11% (6/54) (P <>

Conclusion: The available evidence strongly suggest a switch from empirically started vancomycin to a -lactam as soon as MRSA has been ruled out.


References: click to get abstract/articles

1. Outcome of Vancomycin Treatment in Patients with Methicillin-Susceptible Staphylococcus aureus Bacteremia, Antimicrobial Agents and Chemotherapy, January 2008, p. 192-197