Kato Hideo, Hagihara Mao, Okudaira Masami, Asai Nobuhiro, Koizumi Yusuke, Yamagishi Yuka, Mikamo Hiroshige
Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan.
Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan; Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University Hospital, Aichi, Japan; Tokai Regional Infection Control Study Group (TRICSG).
Int J Antimicrob Agents. 2021 Aug;58(2):106393. doi: 10.1016/j.ijantimicag.2021.106393. Epub 2021 Jun 24.
The aim of this study was to investigate the association between vancomycin trough level and clinical outcomes (mortality and nephrotoxicity) among infected paediatric patients with Gram-positive pathogens. We systematically searched the Scopus, EMBASE, Cochrane Central Register of Controlled Trials, PubMed and CINAHL databases up to March 2020. A total of seven retrospective cohort or case-control studies were included to compare clinical effects and safety: three studies set the threshold of vancomycin trough level at 10 mg/L and the others set it at 15 mg/L. Our analysis showed that vancomycin trough level of 10-15 mg/L was associated with significantly lower mortality [<10 mg/L vs. ≥10 mg/L, odds ratio (OR) = 3.21, 95% confidence interval (CI) 1.74-5.91; and <15 mg/L vs. ≥15 mg/L, OR = 0.31, 95% CI 0.10-0.95). The high vancomycin trough group (≥10 mg/L or ≥15 mg/L) showed a higher incidence of nephrotoxicity (<10 mg/L vs. ≥10 mg/L, OR = 0.06, 95% CI 0.03-0.12; and <15 mg/L vs. ≥15 mg/L, OR = 0.28, 95% CI 0.12-0.65). This is the first meta-analysis to reveal the optimal therapeutic range of vancomycin trough level in children. Our findings strongly suggest a superior benefit of vancomycin trough of 10-15 mg/L for paediatric patients.
本研究旨在调查革兰氏阳性病原体感染的儿科患者中万古霉素谷浓度与临床结局（死亡率和肾毒性）之间的关联。我们系统检索了截至2020年3月的Scopus、EMBASE、Cochrane对照试验中央注册库、PubMed和CINAHL数据库。共纳入七项回顾性队列研究或病例对照研究以比较临床效果和安全性：三项研究将万古霉素谷浓度阈值设定为10mg/L，其他研究将其设定为15mg/L。我们的分析表明，万古霉素谷浓度为10-15mg/L与显著较低的死亡率相关[<10mg/L vs.≥10mg/L，比值比（OR）=3.21，95%置信区间（CI）1.74-5.91；<15mg/L vs.≥15mg/L，OR=0.31，95%CI 0.10-0.95]。万古霉素谷浓度高的组（≥10mg/L或≥15mg/L）显示出较高的肾毒性发生率（<10mg/L vs.≥10mg/L，OR=0.06，95%CI 0.03-0.12；<15mg/L vs.≥15mg/L，OR=0.28，95%CI 0.12-0.65）。这是第一项揭示儿童万古霉素谷浓度最佳治疗范围的荟萃分析。我们的研究结果强烈表明，万古霉素谷浓度为10-15mg/L对儿科患者具有更好的益处。
