Abstract
BackgroundRecent 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.MethodsFrom 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.ResultsHigh 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).ConclusionIn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2252-7) contains supplementary material, which is available to authorized users.
Highlights
Recent guidelines have recommended vancomycin trough levels of 15–20 mg/L for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA)
Association between vancomycin trough levels and nephrotoxicity was largely uniform across the studies included in this meta-analysis; incidence of vancomycin-induced nephrotoxicity varied from study to study
Nephrotoxicity ranges in the van Hal, et al meta-analysis were wider than the ranges in this study due to some differences of the included studies and no limitation regarding the type of MRSA infection included in their study
Summary
Recent guidelines have recommended vancomycin trough levels of 15–20 mg/L for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA). 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. Since 2003, several similar studies have been published in Tongsai and Koomanachai BMC Res Notes (2016) 9:455 which vancomycin-susceptible MRSA strains were identified and clinical failure resulted, despite monitoring and maintenance of trough levels in the recommended range to ensure vancomycin efficacy [3, 4]. As a result of published studies demonstrating vancomycin treatment failure in patients with S. aureus infections who had a vancomycin MIC ≥4 mg/L, the CLSI lowered pre-2006 vancomycin MIC breakpoints by broth microdilution (BMD) from ≤4 to ≤2 μg/mL for susceptible strains of S. aureus
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