Table 1 Summary and characteristics of included studies
Author (Year) Country | Study duration | Study setting | Sample size | Age | Infection type | Outcomes | Key findings |
|---|---|---|---|---|---|---|---|
Retrospective cohort studies | |||||||
Jeffres et al. [42] (2006) USA | Jan 1999 - Jun 2005 | Inpatient including ICU | 102 | Mean age 59.4 ± 15.3 years | MRSA | Mortality, ICU length of stay | Aggressive dosing strategies for vancomycin (e.g., trough concentrations of > 15 g/mL) may not offer any advantage over traditional dose targets (range, 5 to 15 g/mL). |
Hermsen et al. [43] (2010) USA | Jun 2005 - Jun 2007. | Inpatient including ICU | 55 | Mean age 60 years | MRSA | Clinical response, mortality, length of stay, and nephrotoxicity | -Mortality risk was not significantly different between the high (19%) and low (5%) trough group patients (p = 0.1). -LOS did not differ significantly between groups (p = 0.7). -Nephrotoxicity occurred in the low and high groups, respectively, for 10% and 31% (p = 0.04). -There was no significant difference between high and low trough levels on clinical outcomes for MRSA infections. However, nephrotoxicity was higher in the high trough group. |
Kullar et al. [44] (2011) USA | Jan 2005 - Apr 2010 | N/R | 320 | IQR 46–64 years | MRSA | Clinical outcome, treatment failure, and nephrotoxicity. | Vancomycin 10-14.9 mg/l reported more treatment failure (57.8%) and nephrotoxicity (17.1%) than 15–20 mg/l trough levels (39.5%) and nephrotoxicity (13%). |
Clemens et al. [45] (2011) USA | Apr 2008 - Aug 2009 | Inpatient including ICU | 118 | Mean age 53 years (range: 18–89) | MRSA | Treatment failure, clinical efficacy | Treatment outcomes were similar regardless of VAN MIC, although there was a non-statistically significant trend towards decreased clinical efficacy among patients with VAN MIC = 2 mg/L. Optimization of VAN pharmacokinetic indices did not appear to correlate with clinical responses. |
Hou et al. [46] (2021) USA | 2014 to 2015 | ICU | 3,603 | 45.6% ≤ and 53.5% > 60 years | MRSA | ICU and hospital mortality | The mean vancomycin trough concentration (VTC) did not influence reduced ICU/ hospital mortalities, thus suggesting that VTC does not guarantee treatment efficacy for ICU patients. |
Wang et al. [47] (2021) China | Jan 2017 -Dec 2019 | Inpatient | 349 | Mean age 88 years | Complicated Gram-positive infection | Clinical response, 30-day mortality rates, persistent bacteremia, nephrotoxicity | -For patients with VTCs at < 10, 10–15, 15–20, and ≥ 20 µg/mL, the clinical response rates were, respectively, 77.8, 77.0, 80.5, and 61.0%; the 30-day mortality rates were 2.8, 15.0, 15.3, and 37.8%; and the rates of persistent bacteremia were 16.7, 12.4, 11.9, and 11.0%. -Higher VTC level was not associated with favorable treatment outcomes. |
Huang et al. [48] (2018) China | Jan 2007 - Jun 2014 | ICU | 50 | Mean age 85.0 ± 3.9 years | Gram-positive infection | Mortality, clinical outcome, and nephrotoxicity | The 28-day mortality was 26.0% (13/50). Of the patients, 24% (12/50) had nephrotoxicity during the vancomycin treatment. The clinical efficacy was 60%, 86.7%, 58.3%, and 33.3%, and the 28-day mortality rate was 20%, 23.3%, 33.3%, and 33.3%, respectively, when the trough concentrations were ≤ 10 µg/mL, 10–15 µg/mL, 15–20 µg/mL, and ≥ 20 µg/mL. |
Chuma et al. [49] (2018) Japan | Between 2005 and 2015 | ED and ICU | 109 | Mean age 67 years | MRSA, Coagulase-negative Staphylococcus spp, Enterococcus spp | Nephrotoxicity | Nephrotoxicity incidence rate was 14.3% in patients with initial trough levels of 15–20 mg/L, higher than 12.5% in patients with initial trough levels of 10 < 20 mg/L. |
Yahav et al. [50] (2019) Israel | Jan 2013 – Dec 2015 | Inpatient excluding ICU | 285 patients | Mean age 67 ± 15.8 years | MRSA | 30-day all-cause mortality, clinical success, microbiological success, or nephrotoxicity | -There were no significant differences between patients achieving high and low vancomycin levels in mortality (46/131, 35.1% vs. 41/154, 26.6%), clinical success, microbiological success, or nephrotoxicity. -The study found no association between vancomycin levels > = 15 mg/L and clinical outcomes in patients with MRSA infection. |
Arasteh et al. [51] (2019) Iran | NR | ICU | 39 | 42.18 ± 3.84 for low trough and 48.09 ± 9.54 for high trough patients | MRSA | Clinical response and microbiological clearance | -There was no difference between the groups on clinical response (p = 0.677) and microbiological clearance (p = 1.00) -Both patients’ groups had comparable outcomes regardless of trough levels of vancomycin. |
Kralovicova et al. [52] (1997) Slovakia | Jan 1990 to Dec 1995 | Inpatient including ICU | 198 | NR | MRSA | Treatment failure, nephrotoxicity | A high trough level reported more nephrotoxicity (33.3% vs. 11.1%) than a low trough level. |
Prospective cohort studies | |||||||
Bosso et al. [53] (2011) USA | Feb 2008 - Jun 2010 | Inpatient including ICU | 288 | Mean age 55 ± 17 years | MRSA | Nephrotoxicity, ICU length of stay | Vancomycin trough concentrations of > 15 mg/ml associated with a 3-fold increased risk of nephrotoxicity and ICU length of stay. |
Chung et al. [54] (2011) Korea | Aug 2005 - Jul 2007 | ICU | 141 (Intention-to-treat analysis of 68 patients with MRSA) | Mean age 62.7 ± 14 years | MRSA | Treatment success rate, length of ICU stays, and ICU mortality rate | No significant differences were observed in the treatment success rate, length of ICU stay, and ICU mortality rate between patients with vancomycin trough concentrations of > 20 mg/l, 15 to 20 mg/l, and < 15 mg/l. |
Arshad et al. [55] (2012) France | Jul 2005 - Mar 2007 | N/R | 104 | N/R | MRSA | Clinical response, mortality, and nephrotoxicity | A low trough level reported less nephrotoxicity, mortality, and medication failure than a high trough level. |