Association Between Vancomycin Minimum Inhibitory Concentration and Mortality Among Patients With Staphylococcus aureus Bloodstream Infections: A Systematic Review and Meta-analysis

IMPORTANCE: Staphylococcus aureus bacteremia (SAB) is a worldwide problem. It is unclear whether higher-vancomycin minimum inhibitory concentration (MIC) is associated with mortality. This potential association has direct consequences for patients and public health. DATA SOURCES: PubMed, Embase, the Cochrane Library, Evidence-based Medicine BMJ, and the American College of Physicians Journal Club were searched from inception through April 2014. STUDY SELECTION: Studies reporting mortality and vancomycin MIC in patients with SAB were included. DATA EXTRACTION AND SYNTHESIS: Two authors performed the literature search and the study selection separately. Random-effects modeling was used for all analyses. MAIN OUTCOMES AND MEASURES: All-cause mortality. FINDINGS: Among 38 included studies that involved 8291 episodes of SAB, overall mortality was 26.1%. The estimated mortality was 26.8% among SAB episodes (n = 2740) in patients with high-vancomycin MIC (≥1.5 mg/L) compared with 25.8% mortality among SAB episodes (n = 5551) in patients with low-vancomycin MIC (