To the Editor—We read with interest
the new clinical practice guideline for
healthcare-associated ventriculitis and
meningitis published in Clinical Infectious
Diseases [1]. The guideline recommends
consideration of alternative therapies for
the treatment of methicillin-resistant
Staphylococcus aureus (MRSA) meningitis
and ventriculitis for isolates with a
vancomycin minimum in-hibitory
concentration (MIC) ≥1μg/mL. We believe
this recommendation places inappropriate
emphasis on a single determinant of
antimicrobial therapy that has uncertain
clinical relevance and variable accuracy depending on the antimicrobial
susceptibility testing (AST) method
used. This may lead clinicians to use less
well-evidenced strategies in cases likely
to respond to vancomycin
