Systematic review and meta-analysis to explore optimal therapeutic range of vancomycin trough level for infected pediatric patients with Gram-positive pathogens to reduce mortality and nephrotoxicity risk: Meta-analysis of vancomycin trough in children.

The aim of our study was to investigate the association between vancomycin trough level and clinical outcomes (mortality and nephrotoxicity) among infected pediatric patients with Gram-positive pathogens. We systematically searched the Scopus, EMBASE, Cochrane Central Register of Controlled Trials, PubMed, and CINAHL until March 2020. A total of seven retrospective cohort or case-control studies were included: three studies set the threshold of vancomycin trough level at 10 mg/L to compare clinical effects and safety, and the others set at 15 mg/L. Our analysis showed that vancomycin trough level of 10-15 mg/L was associated with significant lower mortality than the others (<10 mg/L vs. ≥10 mg/L, odd rate (OR): 3.21 [95% confidence interval: 1.74-5.91]; <15 mg/L vs. ≥15 mg/L, OR: 0.31 [0.10-0.95]). High vancomycin trough group (≥10 mg/L or ≥15 mg/L) showed higher incidence of nephrotoxicity than the others (< 10 mg/L vs. ≥10 mg/L, OR: 0.28 [0.12-0.65]; <15 mg/L vs. ≥15 mg/L, OR: 0.06 [0.03-0.12]). This is the first meta-analysis to reveal the optimal therapeutic range of vancomycin trough in children. Our findings strongly suggest superior benefit in vancomycin trough of 10-15 mg/L for pediatric patients.