CRD Summary: The authors concluded that it is unclear whether restricting vancomycin use is effective in reducing vancomycin-resistant enterococcus colonisation and infection in U.S. hospitals. Although the search was somewhat restricted and more steps could have been taken to minimise the risk of bias during the review process, given the apparent lack of well-designed studies these cautious conclusions appear justified.

CRD Commentary: The review question and inclusion criteria were clear in most respects, although it was unclear whether there were specific criteria for the vancomycin-reducing intervention. Relevant sources were searched for studies but, as unpublished and non-English studies were excluded, the review is prone to language and publication biases; potential publication bias was not assessed. It was not stated how the study selection or validity assessment processes were conducted and a single reviewer extracted the data, which increases the potential for error and bias. The decision not to meta-analyse the data appears appropriate in view of the heterogeneity between the studies, which was appropriately explored by stratified analyses and was well-addressed in the text. The authors outlined a number of other limitations with the data, notably the poor design of the included studies, with inadequate controls for confounders. Although the search was somewhat restricted and more steps could have been taken to minimise the risk of bias during the review process, given the apparent lack of well-designed studies the authors’ cautious conclusions appear justified.