Relationship Between Vancomycin Trough Serum Concentrations and Clinical Outcomes:A Systematic Review and Meta-Analysis

Objective:Certain studies have shown that treatment failure is not significantly altered when the vancomycin trough serum concentrations are maintained above 15 mg·L -1 . The purpose of this review was to examine the relationships between the vancomycin trough serum concentrations and mortality,treatment failure,and nephrotoxicity. Methods:Pub Med,Embase,the Cochrane Library and three Chinese literature databases（ CNKI,CBM,and Wan Fang） were searched through Jan 16,2014. All studies pertaining to the relationship between the vancomycin trough concentrations and clinical outcomes were included. Two authors（ Ye ZK and Chen K） independently extracted data and assessed the quality of the studies. The quality of the observational studies was assessed using the Newcastle-Ottawa scale. Risk ratios（ RRs）and 95% confidence intervals（ CIs） were calculated for the categorical variables using fixed-effects models if no significant heterogeneity in these variables was detected. The primary outcomes were mortality and treatment failure. The secondary outcome was vancomycin-associated nephrotoxicity. Results:Forty cohort studies were included in this Meta-analysis. Compared with the patients who displayed vancomycin trough concentrations of -1 ,those displaying vancomycin trough concentrations of ≥ 15 mg·L -1 exhibited a lower rate of treatment failure（ RR = 0. 83,95% CI: 0. 70-0. 97,P= 0. 02） and a higher incidence of nephrotoxicity（ RR = 1. 99,95% CI: 1. 56-2. 53,P -1 ,vancomycin trough levels of ≥ 10 or 20 mg·L -1 ,respectively,were associated with a higher incidence of nephrotoxicity. However,the vancomycin trough concentrations were not associated with mortality. Conclusion:Compared with vancomycin trough levels of -1 ,vancomycin trough levels of ≥ 15mg·L -1 were associated with a reduced rate of treatment failure and an increased incidence of nephrotoxicity. The increased risk of nephrotoxicity in patients with vancomycin trough serum concentrations greater than 15 mg·L -1 should be considered.