The monitoring of vancomycin: a systematic review and meta-analyses of area under the concentration-time curve-guided dosing and trough-guided dosing

BMC Infectious Diseases

Satoshi Fujii¹  Yoshio Takesue²  Yoshiko Takahashi³  Kazutaka Oda⁴  Yukihiro Hamada⁵  Toshimi Kimura⁵  Nana Kojima⁶  Moeko Tsutsuura⁶  Kazuaki Taguchi⁶  Yuki Enoki⁶  Sho Tashiro⁶  Sumika Osa⁶  Kazuaki Matsumoto⁶  Yuki Mizukami⁶  Hiromu Moriyama⁶ 

[1] Department of Hospital Pharmacy, Sapporo Medical University Hospital, 16-291, South 1, West 16, Chuo-ku, 060-8543, Sapporo, Hokkaido, Japan;Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, 663-8501, Nishinomiya, Japan;Department of Pharmacy, Hyogo College of Medicine, 1-1, Mukogawa-machi, 663-8501, Nishinomiya, Japan;Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-shi, 860-8556, Kumamoto, Japan;Department of Pharmacy, Tokyo Women’s Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, 162-0054, Tokyo, Japan;Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, 105-8512, Tokyo, Japan;

关键词: Vancomycin;    Trough;    AUC;    Nephrotoxicity;    Meta-analysis;   

DOI  :  10.1186/s12879-021-05858-6

来源: Springer

【 摘 要 】

BackgroundThis systematic review and meta-analysis explored the relationship between vancomycin (VCM) monitoring strategies and VCM effectiveness and safety.MethodsWe conducted our analysis using the MEDLINE, Web of Sciences, and Cochrane Register of Controlled Trials electronic databases searched on August 9, 2020. We calculated odds ratios (ORs) and 95% confidence intervals (CIs).ResultsAdult patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia with VCM trough concentrations ≥15 μg/mL had significantly lower treatment failure rates (OR 0.63, 95% CI 0.47–0.85). The incidence of acute kidney injury (AKI) increased with increased trough concentrations and was significantly higher for trough concentrations ≥20 μg/mL compared to those at 15–20 μg/mL (OR 2.39, 95% CI 1.78–3.20). Analysis of the target area under the curve/minimum inhibitory concentration ratios (AUC/MIC) showed significantly lower treatment failure rates for high AUC/MIC (cut-off 400 ± 15%) (OR 0.28, 95% CI 0.18–0.45). The safety analysis revealed that high AUC value (cut-off 600 ± 15%) significantly increased the risk of AKI (OR 2.10, 95% CI 1.13–3.89). Our meta-analysis of differences in monitoring strategies included four studies. The incidence of AKI tended to be lower in AUC-guided monitoring than in trough-guided monitoring (OR 0.54, 95% CI 0.28–1.01); however, it was not significant in the analysis of mortality.ConclusionsWe identified VCM trough concentrations and AUC values that correlated with effectiveness and safety. Furthermore, compared to trough-guided monitoring, AUC-guided monitoring showed potential for decreasing nephrotoxicity.

【 授权许可】

CC BY