Pharmacy Services, Alberta Health Services, Calgary, Alberta, Canada.
Pharmacy Services, Alberta Health Services, Calgary, Alberta, Canada.
Clin Microbiol Infect. 2020 Apr;26(4):436-446. doi: 10.1016/j.cmi.2019.10.029. Epub 2019 Nov 20.
Vancomycin is a first-line antibiotic for methicillin-resistant Staphylococcus aureus infections or other Gram-positive infections. The area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio is proposed as a therapeutic drug-monitoring parameter. How well clinical efficacy is predicted by this measure has not been established.
Determine the test performance characteristics (TPC) of AUC:MIC of vancomycin for prediction of positive outcome.
PubMed and Ovid Medline (1946 to 2018) and EMBASE (1974 to 2018). Study Eligibility Criteria and Participants: Studies of patients treated with vancomycin for any type of infection in peer reviewed publications. All patient populations were included.
Vancomycin AUC:MIC or AUC was related to patient clinical outcome.
Searches of medical databases using relevant terms were performed. Screening, study reviewing, data extracting and assessing data quality was performed independently by two reviewers. Studies were stratified by type of primary outcome for calculation of pooled sensitivity, specificity and construction of hierarchical summary receiver operating characteristic (HSROC) curves.
Nineteen studies including 1699 patients were meta-analysed. Pooled sensitivity and specificity were 0.77 (95% CI 0.67-0.84) and 0.62 (95% CI 0.53-0.71) respectively for the seven studies with primary outcome of mortality and 0.65 (95% CI 0.53-0.75), 0.58 (95% CI 0.48-0.67) for studies with composite or clinical cure outcome (n = 12). HSROC curves suggested considerable heterogeneity. An additional 11 studies were described but could not be included for meta-analysis because data were not available. The majority of these studies (9/11) failed to demonstrate a relationship between AUC:MIC and positive clinical outcome.
Vancomycin AUC:MIC performance was modest and inconsistent. Analysis was limited by studies without sufficient data; therefore, meta-analytic results may overestimate TPC values. Given this, as well as the lack of standardization of methods, widespread adoption of AUC:MIC as the preferred vancomycin monitoring parameter may be premature.
万古霉素是治疗耐甲氧西林金黄色葡萄球菌感染或其他革兰氏阳性感染的一线抗生素。曲线下面积（AUC）与最低抑菌浓度（MIC）比值被提议作为治疗药物监测的参数。但该指标预测临床疗效的效果尚未确定。
确定万古霉素 AUC:MIC 预测阳性结局的测试性能特征（TPC）。
PubMed 和 Ovid Medline（1946 年至 2018 年）和 EMBASE（1974 年至 2018 年）。研究入选标准和参与者：在同行评审出版物中，对接受万古霉素治疗的任何类型感染的患者进行的研究。所有患者群体均包括在内。
万古霉素 AUC:MIC 或 AUC 与患者临床结局相关。
使用相关术语对医学数据库进行了搜索。筛选、研究回顾、数据提取和数据质量评估由两位评审员独立进行。根据主要结局类型对研究进行分层，以计算汇总敏感性、特异性和构建分层汇总受试者工作特征（HSROC）曲线。
19 项研究共纳入 1699 例患者，进行了荟萃分析。7 项以死亡率为主要结局的研究中，汇总敏感性和特异性分别为 0.77（95% CI 0.67-0.84）和 0.62（95% CI 0.53-0.71），12 项以复合或临床治愈为主要结局的研究中，汇总敏感性和特异性分别为 0.65（95% CI 0.53-0.75）和 0.58（95% CI 0.48-0.67）。HSROC 曲线表明存在相当大的异质性。另外还描述了 11 项研究，但由于数据不可用，无法进行荟萃分析。这些研究中的大多数（9/11）未能证明 AUC:MIC 与阳性临床结局之间存在关联。
万古霉素 AUC:MIC 的性能中等且不一致。分析受到缺乏足够数据的研究的限制；因此，荟萃分析结果可能高估了 TPC 值。鉴于此，以及方法缺乏标准化，广泛采用 AUC:MIC 作为首选的万古霉素监测参数可能还为时过早。
