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

• Published in: BMC infectious diseases Vol. 21; no. 1; pp. 153 - 15
• Main Authors: Tsutsuura, Moeko, Moriyama, Hiromu, Kojima, Nana, Mizukami, Yuki, Tashiro, Sho, Osa, Sumika, Enoki, Yuki, Taguchi, Kazuaki, Oda, Kazutaka, Fujii, Satoshi, Takahashi, Yoshiko, Hamada, Yukihiro, Kimura, Toshimi, Takesue, Yoshio, Matsumoto, Kazuaki
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.02.2021; BioMed Central; BMC
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - epidemiology; Adult; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Area Under Curve; AUC; Bacteremia; Bacteremia - drug therapy; Clinical trials; Confidence intervals; Dosage and administration; Drug Monitoring - methods; Drug resistance; Drug utilization; Failure rates; Gram-positive bacteria; Human subjects; Humans; Kidneys; Medical research; Medicine, Experimental; Meta-analysis; Methicillin; Methicillin-Resistant Staphylococcus aureus - drug effects; Methods; Microbial Sensitivity Tests; Minimum inhibitory concentration; Monitoring; Mortality; Nephrotoxicity; Odds Ratio; Questionnaires; Safety; Safety analysis; Staphylococcal Infections - drug therapy; Staphylococcus aureus; Staphylococcus infections; Success; Systematic review; Telemedicine; Treatment Failure; Trough; Vancomycin; Vancomycin - pharmacology; Vancomycin - therapeutic use; Japan; Vancomycin; Trough; Nephrotoxicity; AUC; Meta-analysis
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-05858-6

This systematic review and meta-analysis explored the relationship between vancomycin (VCM) monitoring strategies and VCM effectiveness and safety. 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). 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. 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.