高与低万古霉素谷浓度在治疗耐甲氧西林金黄色葡萄球菌感染患者中的安全性和有效性：一项荟萃分析。

The safety and efficacy of high versus low vancomycin trough levels in the treatment of patients with infections caused by methicillin-resistant Staphylococcus aureus: a meta-analysis.

作者信息

Tongsai Sasima, Koomanachai Pornpan

机构信息

Clinical Epidemiology Unit, Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand.

Division of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand.

出版信息

BMC Res Notes. 2016 Sep 29;9(1):455. doi: 10.1186/s13104-016-2252-7.

BACKGROUND

Recent guidelines have recommended vancomycin trough levels of 15-20 mg/L for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, high trough levels may increase risk of nephrotoxicity and mortality, and high vancomycin trough levels have not been well studied. This study was designed to combine safety and efficacy results from independent studies and to compare between high and low vancomycin trough levels in the treatment of MRSA-infected patients using meta-analysis.

METHODS

From 19 eligible studies, 9 studies were included in meta-analysis to compare clinical success between high and low vancomycin trough levels, while 10 and 11 studies met criteria for comparing trough levels and nephrotoxicity and trough levels and mortality, respectively. The PubMed/Medline, Web of Science, and Scopus databases, and hand searching were used to identify eligible studies dated up to March 2016. Of 2344 subjects with MRSA infection, 1036 were assigned to trough levels ≥15 mg/L and 1308 to trough levels <15 mg/L.

RESULTS

High vancomycin trough levels were found to be associated with risk of nephrotoxicity (odds ratio [OR] 2.14, 95 % confidence interval [CI] 1.42-3.23 and adjusted OR 3.33, 95 % CI 1.91-5.79). There was no evidence of difference between high and low vancomycin trough levels for mortality (OR; 1.09; 95 % CI 0.75-1.60) or clinical success (OR 1.07; 95 % CI 0.68-1.68).

CONCLUSION

In this study, high vancomycin trough levels were identified as an independent factor associated with risk of nephrotoxicity in MRSA-infected patients. Association between vancomycin trough levels and both adverse effects and clinical outcomes requires further study.

背景

近期指南推荐万古霉素谷浓度为15 - 20mg/L用于治疗耐甲氧西林金黄色葡萄球菌（MRSA）引起的严重感染。然而，高谷浓度可能增加肾毒性和死亡风险，且高万古霉素谷浓度尚未得到充分研究。本研究旨在综合独立研究的安全性和有效性结果，并通过荟萃分析比较高、低万古霉素谷浓度在治疗MRSA感染患者中的差异。

方法

从19项符合条件的研究中，9项研究纳入荟萃分析以比较高、低万古霉素谷浓度的临床成功率，而分别有10项和11项研究符合比较谷浓度与肾毒性以及谷浓度与死亡率的标准。使用PubMed/Medline、科学网和Scopus数据库，并通过手工检索来识别截至2016年3月的符合条件的研究。在2344例MRSA感染患者中，1036例被分配至高谷浓度≥15mg/L组，1308例被分配至低谷浓度<15mg/L组。

结果

发现高万古霉素谷浓度与肾毒性风险相关（比值比[OR]2.14，95%置信区间[CI]1.42 - 3.23，校正OR 3.33，95%CI 1.91 - 5.79）。在死亡率（OR；1.09；95%CI 0.75 - 1.60）或临床成功率（OR 1.07；95%CI 0.68 - 1.68）方面，高、低万古霉素谷浓度之间没有差异证据。