Central Pharmacy, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Ostmerheimer Str. 200, 51109 Cologne, Germany; Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Ostmerheimer Str. 200, 51109 Cologne, Germany; Division of Hygiene and Environmental Medicine, Department of Human Medicine, Faculty of Health, Witten/Herdecke University, Witten, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany.
Central Pharmacy, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Ostmerheimer Str. 200, 51109 Cologne, Germany; Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Ostmerheimer Str. 200, 51109 Cologne, Germany; Division of Hygiene and Environmental Medicine, Department of Human Medicine, Faculty of Health, Witten/Herdecke University, Witten, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany.
Int J Antimicrob Agents. 2023 Dec;62(6):107005. doi: 10.1016/j.ijantimicag.2023.107005. Epub 2023 Oct 13.
Vancomycin is used to treat Gram-positive infections in critically ill adults. For vancomycin administered by continuous infusion (CI), various target ranges have been used, ranging from 15-20 mg/L to 30-40 mg/L. This systematic literature review was conducted to investigate the impact of steady-state serum concentration (C) of CI on safety and efficacy of therapy in critically ill adults.
Relevant literature was identified by searching two electronic databases (PubMed, Cochrane Library) and Google Scholar from inception until July 2023, focusing on studies reporting measured C and treatment outcomes (e.g. mortality, nephrotoxicity) with CI. Due to study heterogeneity, a narrative synthesis of the evidence was performed.
Twenty-one publications were included with a total of 2949 patients. Mortality was higher (two studies, n = 388 patients) and clinical cure was lower (one study, n = 40 patients) with C < 15 mg/L measured 24 h after initiation of CI (C). An adequate loading dose appeared most important for maintaining higher C. Generally, higher C was associated with higher rates of acute kidney injury (AKI) (15 studies, n = 2331 patients). It was calculated that C < 25 mg/L (versus ≥25 mg/L) was preferable for reducing nephrotoxicity (three studies, n = 515 patients).
Despite sparse data availability, the target range of 15-25 mg/L in CI may increase clinical cure and reduce mortality and AKI. In future research, vancomycin C cohorts should be formed to allow evaluation of the impact of C of CI on treatment outcomes.
万古霉素用于治疗重症成人的革兰氏阳性感染。对于连续输注（CI）给予的万古霉素，已经使用了各种目标范围，从 15-20mg/L 到 30-40mg/L 不等。本系统文献综述旨在研究 CI 稳态血清浓度（C）对重症成人治疗的安全性和疗效的影响。
通过搜索两个电子数据库（PubMed、Cochrane Library）和 Google Scholar 从成立到 2023 年 7 月，确定了相关文献，重点是报告 CI 测量 C 和治疗结果（例如死亡率、肾毒性）的研究。由于研究的异质性，对证据进行了叙述性综合。
纳入了 21 篇文献，共 2949 例患者。在 CI 开始后 24 小时测量 C < 15mg/L 时，死亡率较高（两项研究，n = 388 例患者），临床治愈率较低（一项研究，n = 40 例患者）。足够的负荷剂量似乎对维持较高的 C 最为重要。一般来说，较高的 C 与急性肾损伤（AKI）的发生率较高有关（15 项研究，n = 2331 例患者）。据计算，C < 25mg/L（与 ≥25mg/L 相比）更有利于降低肾毒性（三项研究，n = 515 例患者）。
尽管数据有限，CI 中的目标范围 15-25mg/L 可能会提高临床治愈率，降低死亡率和 AKI。在未来的研究中，应形成万古霉素 C 队列，以评估 CI 的 C 对治疗结果的影响。
