Glycopeptide Heteroresistance Among Coagulase-Negative Staphylococci: A Systematic Review and Meta-analysis

Area of Science:

• Microbiology
• Infectious Diseases
• Antimicrobial Resistance

Background:

• Coagulase-negative staphylococci (CoNS) are significant opportunistic pathogens.
• Increasing antimicrobial resistance in CoNS poses a clinical challenge.
• Glycopeptides are critical antibiotics for treating resistant staphylococcal infections.

Purpose of the Study:

• To determine the prevalence of glycopeptide heteroresistance in CoNS.
• To identify factors associated with glycopeptide heteroresistance.
• To assess the clinical significance of glycopeptide heteroresistance in CoNS infections.

Main Methods:

• Meta-analysis of published studies on glycopeptide heteroresistance in CoNS.
• Inclusion of data from 1432 isolates across multiple studies.
• Statistical analysis to determine prevalence and associations.

Main Results:

• A high prevalence of glycopeptide heteroresistance was identified in CoNS (41.4%).
• Glycopeptide heteroresistance was associated with methicillin resistance.
• This resistance did not necessitate prior glycopeptide exposure and may be higher in invasive infections.

Conclusions:

• Glycopeptide heteroresistance is a common phenomenon in CoNS.
• It is linked to methicillin resistance and may contribute to treatment failures.
• This under-appreciated resistance mechanism warrants further clinical attention.