β-lactam antibiotics vs vancomycin in treating methicillin-sensitive staphylococcus aureus bloodstream infections: a meta-analysis of clinical outcomes.

BACKGROUND

This meta-analysis systematically reviews and compares the efficacy of β-lactam antibiotics and vancomycin in the treatment of methicillin-sensitive Staphylococcus aureus (MSSA) bloodstream infections, with the aim of providing evidence-based recommendations for clinical decision-making.

METHODS

This systematic review and meta-analysis followed the PRISMA 2020 guidelines and was registered with PROSPERO. Two independent reviewers conducted comprehensive literature searches across multiple databases, specifically targeting Randomized Controlled Trial (RCT) and non-RCT comparing β-lactam antibiotics and vancomycin in treating MSSA bloodstream infections. Outcomes analyzed included mortality within 30 days and 90 days, defervescence time, bacterial clearance time, and treatment duration.

RESULTS

Seven retrospective cohort studies involving a total of 6957 patients were included. The pooled results indicated no significant difference in 30-day and 90-day mortality or treatment duration between the two antibiotics regimens. However, β-lactam antibiotics demonstrated a faster action, with significantly shorter times for fever reduction and bacterial clearance compared to vancomycin.

CONCLUSIONS

This study found that β-lactam antibiotics are more efficacious than vancomycin in treating MSSA bloodstream infections. Although clinical outcomes such as mortality and treatment duration were similar between the groups, the faster clinical response observed with β-lactam antibiotics supports their preferential use in cases of MSSA infection. Since all included studies were retrospective, the overall reliability of the evidence is affected. Future high-quality prospective studies are needed to further validate these findings.