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Vancomycin for prophylaxis against sepsis in preterm neonates

Premature babies have immature immune systems and frequently pick up harmful infections in the hospital. This means they are at high risk of sepsis (life‐threatening bacterial infection). The most common bacteria causing sepsis in neonatal intensive care are coagulase negative staphylococci (CoNS). One way of trying to prevent CoNS infection is by infusing low doses of the antibiotic vancomycin (giving the drug by intermittent infusion or continuous drip). The review of trials found that low dose continuous infusions, or low dose intermittent administration, of vancomycin reduce the risk of a baby getting sepsis in the neonatal intensive care unit. There is not enough evidence to show if this approach increases antibiotic resistance in nurseries.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Teicoplanin versus vancomycin for proven or suspected infection

One of the most common bacteria responsible for human diseases is Staphylococcus aureus, which causes mainly skin, lung and blood infections. In many cases, especially in infections acquired inside a hospital, usual antibiotics are ineffective and more aggressive drugs are needed. Teicoplanin and vancomycin are both effective against this bacteria, however, there is a concern that vancomycin may be more toxic, especially for the kidneys. This review identified 24 studies enrolling 2,610 patients comparing teicoplanin and vancomycin in those with either proven or suspected infection. Teicoplanin was as effective as vancomycin for treating infections caused by Staphylococcus aureus with similar results for clinical cure, microbiological cure and death. However, there were less adverse events (skin rash and red man syndrome) and it caused significantly less damage to the kidneys.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Screening, Isolation, and Decolonization Strategies for Vancomycin-Resistant Enterococci or Extended Spectrum Beta-Lactamase Producing Organisms: A Systematic Review of the Clinical Evidence and Health Services Impact [Internet]

Bacterial resistance to antibiotics is an increasing problem in Canada and worldwide. Vancomycin-resistant enterococci (VRE) are strains of Enterococcus faecium or Enterococcus faecalis that contain genes conferring resistance to vancomycin. Escherichia coli (E. coli), Klebsiella pneumonia (K. pneumonia), and other gram-negative bacteria may produce the enzymes known as extended spectrum beta-lactamases (ESBL). These have the ability to inactivate beta lactam antibiotics such as penicillin, ampicillin, and the cephalosporins.

Rapid Response Report: Systematic Review - Canadian Agency for Drugs and Technologies in Health.

Version: September 2012
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Vancomycin or Metronidazole for Treatment of Clostridium difficile Infection: Clinical and Economic Analyses [Internet]

Clostridium difficile (C. difficile) infection is the most common cause of nosocomial infectious diarrhea in adults. The spread of a hypervirulent strain of C. difficile has caused recent outbreaks of C. difficile infection. Metronidazole and vancomycin are the antibiotics of choice to treat C. difficile infection. An assessment was prepared to help guide the choice of therapy for C. difficile infection and to inform reimbursement policies in the Canadian publicly funded health care system.

CADTH Technology Report - Canadian Agency for Drugs and Technologies in Health.

Version: January 2011
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Linezolid versus vancomycin for gram-positive bacteraemia: a systematic review

Bibliographic details: Yue J R, Fang C L, Zhang X M, Dong B R.  Linezolid versus vancomycin for gram-positive bacteraemia: a systematic review . Chinese Journal of Evidence-Based Medicine 2009; 9(6): 646-651

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Effects and safety of linezolid vs vancomycin for the treatment of patients with MRSA: meta analysis of randomized controlled trials

Bibliographic details: Li Y, Tang HL, Hu YF, Peng FC.  Effects and safety of linezolid vs vancomycin for the treatment of patients with MRSA: meta analysis of randomized controlled trials. Chinese Pharmaceutical Journal 2011; 46(13): 1041-1046 Available from: http://www.zgyxzz.com.cn/EN/abstract/abstract27239.shtml

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Linezolid versus vancomycin for treatment of Gram-positive cocci infections: meta-analysis of randomised controlled trials

Bibliographic details: Huang YL, Zhang SZ, Huang Q, Ma H, Lin ZQ.  Linezolid versus vancomycin for treatment of Gram-positive cocci infections: meta-analysis of randomised controlled trials. Chinese Journal of Antibiotics 2012; 37(7): 545-557 Available from: http://d.wanfangdata.com.cn/periodical_zgksszz201207012.aspx

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Teicoplanin versus vancomycin for severe Gram-positive bacterial infection: a systematic review

Bibliographic details: Bao D, Li Y, Chang XH.  Teicoplanin versus vancomycin for severe Gram-positive bacterial infection: a systematic review. Chinese Journal of Evidence-Based Medicine 2014; 14(7): 841-848 Available from: http://www.cjebm.org.cn/oa/DArticle.aspx?type=view&id=20140704

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Risk of hepatic events in patients treated with vancomycin in clinical studies: a systematic review and meta-analysis

BACKGROUND: Routine surveillance of spontaneous reporting data and subsequent disproportionality analyses have indicated that the use of vancomycin might be associated with an increased risk of hepatic events.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Use of vancomycin-containing lock or flush solutions for prevention of bloodstream infection associated with central venous access devices: a meta-analysis of prospective, randomized trials

BACKGROUND: Prolonged exposure to central venous access devices carries significant risk of device-associated bloodstream infection (BSI), which is associated with morbidity, added health care costs, and attributable mortality. We aimed to determine the efficacy of vancomycin-heparin lock or flush solution in preventing BSI in patients being treated with long-term central venous intravascular devices (IVDs).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Comparative efficacy and safety of vancomycin versus teicoplanin: systematic review and meta-analysis

Vancomycin and teicoplanin are the glycopeptides currently in use for the treatment of infections caused by invasive beta-lactam-resistant gram-positive organisms. We conducted a systematic review and meta-analysis of randomized controlled trials that have compared vancomycin and teicoplanin administered systemically for the treatment of suspected or proven infections. A comprehensive search of trials without year, language, or publication status restrictions was performed. The primary outcome was all-cause mortality. Two reviewers independently extracted the data. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled by using the fixed-effect model (RRs of >1 favor vancomycin). Twenty-four trials were included. All-cause mortality was similar overall (RR, 0.95; 95% CI, 0.74 to 1.21), and there was no significant heterogeneity. In trials that used adequate allocation concealment, the results favored teicoplanin (RR, 0.82; 95% CI, 0.63 to 1.06), while in trials with unknown methods or inadequate concealment, the results favored vancomycin (RR, 3.61; 95% CI, 1.27 to 10.30). The latter trials might have recruited more severely ill patients. No other variable affected the RRs for mortality, including the assessment of glycopeptides administered empirically or for proven infections, neutropenia, the participant's age, and drug dosing. There were no significant differences between teicoplanin and vancomycin with regard to clinical failure (RR, 0.92; 95% CI, 0.81 to 1.05), microbiological failure (RR, 1.24; 95% CI, 0.93 to 1.65), and other efficacy outcomes. Lower RRs (in favor of teicoplanin) for clinical failure were observed with a lower risk of bias and when treatment was initiated for infections caused by gram-positive organisms rather than empirically. Total adverse events (RR, 0.61; 95% CI, 0.50 to 0.74), nephrotoxicity (RR, 0.44; 95% CI, 0.32 to 0.61), and red man syndrome were significantly less frequent with teicoplanin. Teicoplanin is not inferior to vancomycin with regard to efficacy and is associated with a lower adverse event rate than vancomycin.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

[Linezolid versus vancomycin in the treatment of pneumonia caused by Gram-positive cocci: meta-analysis of randomised controlled trials]

OBJECTIVE: To study the randomised controlled trials on the efficacy and safety in patients with pneumonia caused by Gram-positive cocci treated with linezolid versus with vancomycin.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Impact of vancomycin minimum inhibitory concentration on clinical outcomes of patients with vancomycin-susceptible Staphylococcus aureus infections: a meta-analysis and meta-regression

Although the vancomycin minimum inhibitory concentration (VMIC) susceptibility breakpoint for Staphylococcus aureus was recently lowered to ≤2 mg/L, it is argued that isolates in the higher levels of the susceptible range may bear adverse clinical outcomes. Clinical outcomes (all-cause mortality and treatment failure) of patients with S. aureus infections by 'high-VMIC' (conventionally defined as VMIC >1 mg/L but ≤2 mg/L) and 'low-VMIC' (VMIC≤1 mg/L) isolates were compared by performing a systematic review and meta-analysis. The effect of potential confounders was assessed by univariate meta-regression analyses. In total, 33 studies (6210 patients) were included. Most studies were retrospective (28/33), used the Etest (22/33) and referred to meticillin-resistant S. aureus (MRSA) infections (26/33) and bacteraemia (23/33). Irrespective of VMIC testing method, meticillin resistance and site of infection, the high-VMIC group had higher mortality [relative risk (RR)=1.21 (95% confidence interval 1.03-1.43); 4612 patients] and more treatment failures [RR=1.67 (1.26-2.21); 2049 patients] than the low-VMIC group. The results were not affected by the potential confounders and were reproduced in the subset of patients with MRSA infections [mortality, RR=1.19 (1.02-1.40), 2956 patients; treatment failure, RR=1.69 (1.26-2.25), 1793 patients]. In conclusion, infection by vancomycin-susceptible S. aureus with VMIC>1mg/L appears to be associated with higher mortality than VMIC≤1mg/L. Further research is warranted to verify these results and to assess the impact of VMIC on meticillin-susceptible S. aureus infections. Evaluation of alternative antimicrobial agents also appears justified.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Vancomycin prophylaxis of surgical site infection in clean orthopedic surgery

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as a public health concern since the mid-1990s. Because of the increase in reports of this pathogen, it has become increasingly tempting for clinicians to provide prophylaxis against this entity using antibiotics known to be effective against MRSA. The goal of this study was to assess the use of MRSA prophylaxis to determine whether it is safe and effective. A systematic search of the literature was performed to identify articles that examined the use of vancomycin in clean orthopedic surgery. Infection rates and adverse events were extracted, and the data were aggregated and analyzed using a DerSimonian and Laird random effects model. Publication bias and study quality were also assessed. No benefit of parenteral administration of vancomycin was identified. Local, vancomycin-impregnated cement and powder are associated with lower infection rates. Few adverse events occurred, and most of those that occurred involved infusion rate.Cost, resistance, and side effects are concerns in using vancomycin therapy in addition to standard antibiotic prophylaxis. Given the lack of efficacy of intravenous vancomycin, the authors do not recommend its routine use in clean orthopedic surgery. However, local administration appears to be safe and effective. The data are most compelling in orthopedic spine surgery in which a patient without prophylaxis is more than 4 times as likely to have a deep postoperative wound infection compared with a patient who received local vancomycin. The authors recommend the use of local antibiotics when possible in clean orthopedic surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Treatment considerations in vancomycin-resistant enterococcal bacteremia: daptomycin or linezolid? A review.

BACKGROUND: Vancomycin resistant enterococcal bloodstream infections are an important cause of morbidity and mortality in hospitalized patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

High versus low vancomycin serum trough regimen for Gram-positive infections: a meta-analysis

This study aimed to evaluate the impact of high vancomycin serum trough concentrations (≧15 mg/l) on clinical outcomes and nephrotoxicity among adult subjects. We searched MEDLINE, Cochrane Library, and CNKI systematically. A total of 17 studies were included. Meta-analysis found that high trough group showed no significant difference comparing to low trough group in treatment failure [relative risk (RR) 0·91, 95% confidence interval (CI) 0·67-1·24; P = 0·57] and all-cause mortality (RR 1·14, 95% CI 0·81-1·59; P = 0·46). However, the high trough concentrations were associated with lower treatment failure in bacteremia subgroup (RR 0·72, 95% CI 0·59-0·88; P = 0·001). High trough concentrations were associated with an increased risk of vancomycin-induced nephrotoxicity (RR 2·06, 95% CI 1·52-2·79; P<0·00001). Our meta-analysis indicates that high trough concentrations were not significantly superior to low trough concentrations in lowering treatment failure and mortality. Moreover, high trough concentrations significantly increased the risk of nephrotoxicity.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Application of vancomycin powder into the wound during spine surgery: systematic review and meta-analysis

OBJECTIVE: To determine the effects of applying vancomycin powder within the surgical wound on the risk of surgical infections, pseudo-arthrosis and adverse events, in patients undergoing spinal surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Topical intrawound application of vancomycin powder in addition to intravenous administration of antibiotics: a meta-analysis on the deep infection after spinal surgeries

BACKGROUND: The intrawound application of vancomycin powder in addition to intravenous administration of antibiotics has been reported to be an easy and cost-efficient technique for reducing the deep infection, which is a serious complication of spinal surgeries. The aim of the present meta-analysis was to derive a preliminary estimation on the clinical performance of this technique.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Neonatal vancomycin continuous infusion: still a confusion?

BACKGROUND: Continuous infusions of vancomycin over 24 hours have been shown in adults to reduce drug toxicity, lower treatment costs and require fewer blood samples for therapeutic drug monitoring. They may also improve clinical outcome through earlier attainment of target drug concentrations. In neonates, there is no consensus on vancomycin dosing. We reviewed the literature to assess the evidence for vancomycin dosing regimens for continuous infusion in neonates.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Effects of daily bathing with chlorhexidine and acquired infection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: a meta-analysis

OBJECTIVE: Chlorhexidine gluconate (CHG) is a common and safe antimicrobial agent and has been used widely in hand hygiene and skin disinfection; however, whether daily bathing with CHG results in the reduced acquired infection of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) remains inconclusive.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

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