In a new meta-analysis, β-lactam antibiotics demonstrated significantly faster clinical response times than vancomycin in patients with methicillin-sensitive Staphylococcus aureus (MSSA) bloodstream infections, suggesting a potential shift in first-line treatment choices. While mortality and treatment duration were similar across both regimens, patients receiving β-lactams achieved more rapid defervescence and bacterial clearance.
This systematic review, registered with PROSPERO and adhering to PRISMA 2020 guidelines, evaluated seven retrospective cohort studies comprising 6,957 patients. It aimed to assess and compare the clinical efficacy of β-lactams and vancomycin in MSSA bloodstream infections, a common and serious condition frequently encountered in U.S. hospitals.
Despite long-standing use of vancomycin in empirical therapy, especially in institutions with high rates of methicillin-resistant S. aureus, this meta-analysis found no significant difference in 30- or 90-day mortality between the two antibiotic classes. Likewise, overall treatment durations were comparable. However, β-lactams provided more rapid symptom resolution and microbiologic clearance, suggesting better efficiency in infection control.
These findings bolster existing clinical sentiment that once MSSA is confirmed, β-lactam agents, such as nafcillin or cefazolin, should be favored over glycopeptides. The implications are clinically relevant for tailoring therapy, minimizing complications from prolonged bacteremia, and optimizing hospital resource use.
The authors do caution that all included studies were retrospective in design, introducing potential biases and limiting the strength of recommendations. High-quality prospective trials are warranted to confirm these outcomes and further inform antibiotic stewardship.
For now, the evidence supports clinicians transitioning patients to β-lactam therapy promptly upon confirmation of MSSA to enhance recovery rates and reduce the burden of persistent infection.
Reference:
Yu G et al. β-lactam antibiotics vs vancomycin in treating methicillin-sensitive staphylococcus aureus bloodstream infections: a meta-analysis of clinical outcomes. Eur J Clin Microbiol Infect Dis. 2025. doi: 10.1007/s10096-025-05164-y. [Online ahead of print].
