Moeko Tsutsuura1, Hiromu Moriyama1, Nana Kojima1, Yuki Mizukami1, Sho Tashiro1, Sumika Osa1, Yuki Enoki2, Kazuaki Taguchi1, Kazutaka Oda3, Satoshi Fujii4, Yoshiko Takahashi5, Yukihiro Hamada6, Toshimi Kimura6, Yoshio Takesue7, Kazuaki Matsumoto1. 1. Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan. 2. Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan. enoki-yk@pha.keio.ac.jp. 3. Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan. 4. Department of Hospital Pharmacy, Sapporo Medical University Hospital, 16-291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. 5. Department of Pharmacy, Hyogo College of Medicine, 1-1, Mukogawa-machi, Nishinomiya, 663-8501, Japan. 6. Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan. 7. Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, 663-8501, Japan.
Abstract
BACKGROUND: This systematic review and meta-analysis explored the relationship between vancomycin (VCM) monitoring strategies and VCM effectiveness and safety. METHODS: We 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). RESULTS: Adult 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. CONCLUSIONS: We 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.
BACKGROUND: This systematic review and meta-analysis explored the relationship between vancomycin (VCM) monitoring strategies and VCM effectiveness and safety. METHODS: We 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). RESULTS: Adult 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. CONCLUSIONS: We 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.
Authors: Michael J Rybak; Jennifer Le; Thomas P Lodise; Donald P Levine; John S Bradley; Catherine Liu; Bruce A Mueller; Manjunath P Pai; Annie Wong-Beringer; John C Rotschafer; Keith A Rodvold; Holly D Maples; Benjamin M Lomaestro Journal: Am J Health Syst Pharm Date: 2020-05-19 Impact factor: 2.637
Authors: Catherine Liu; Arnold Bayer; Sara E Cosgrove; Robert S Daum; Scott K Fridkin; Rachel J Gorwitz; Sheldon L Kaplan; Adolf W Karchmer; Donald P Levine; Barbara E Murray; Michael J Rybak; David A Talan; Henry F Chambers Journal: Clin Infect Dis Date: 2011-02-01 Impact factor: 9.079
Authors: Gwendolyn M Pais; Sean N Avedissian; J Nicholas O'Donnell; Nathaniel J Rhodes; Thomas P Lodise; Walter C Prozialeck; Peter C Lamar; Cameron Cluff; Anil Gulati; Julie C Fitzgerald; Kevin J Downes; Athena F Zuppa; Marc H Scheetz Journal: Antimicrob Agents Chemother Date: 2019-06-24 Impact factor: 5.191
Authors: Thomas P Lodise; Nimish Patel; Ben M Lomaestro; Keith A Rodvold; George L Drusano Journal: Clin Infect Dis Date: 2009-08-15 Impact factor: 9.079
Authors: B R Dalton; I Rajakumar; A Langevin; C Ondro; D Sabuda; T P Griener; D Dersch-Mills; E Rennert-May Journal: Clin Microbiol Infect Date: 2019-11-20 Impact factor: 8.067
Authors: Thomas P Lodise; Marc Scheetz; Joseph J Carreno; Henry Chambers; Vance Fowler; Thomas L Holland Journal: Open Forum Infect Dis Date: 2022-01-22 Impact factor: 4.423
Authors: Peter Pickkers; Michael Darmon; Eric Hoste; Michael Joannidis; Matthieu Legrand; Marlies Ostermann; John R Prowle; Antoine Schneider; Miet Schetz Journal: Intensive Care Med Date: 2021-07-02 Impact factor: 17.440