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Adolescent Health, Medicine and... 2018is responsible for 10% of hospital-acquired infections. The purpose of this review was to evaluate the prevalence of vancomycin-resistant (VRE) isolates in Iran using... (Review)
Review
INTRODUCTION
is responsible for 10% of hospital-acquired infections. The purpose of this review was to evaluate the prevalence of vancomycin-resistant (VRE) isolates in Iran using a meta-analysis method.
MATERIALS AND METHODS
Iranian databases, including Magiran and IranDoc, and international databases, including PubMed and MedLib, were examined carefully, and a total of 20 articles published between 2000 and 2011 were extracted. The data were subjected to meta-analysis and random-effects models. In addition, heterogeneous studies were assessed using the index. Finally, the data were analyzed using R and STATA software.
RESULTS
The results showed that the strain of had been more common than in clinical infection (69% vs 28%). However, resistance to vancomycin was higher among strains of compared with strains of (33% vs 3%). The complete resistance, intermediate resistance, and sensitivity to vancomycin among isolates were 14% (95% CI: 11, 18), 14% (95% CI: 5, 23), and 74% (95% CI: 65, 83), respectively. The resistance patterns, depending on the sample type, did not show a significant difference. In addition, the resistance of isolated strains to vancomycin in outpatients was significantly higher than that in inpatients (16% vs 1%). Moreover, 80%-86% of resistant strains were genotype van A and 14%-20% of resistant strains were genotype van B.
CONCLUSION
The findings of the present review show that there is a high frequency of resistant in Iran. Therefore, consideration of the prevalence and frequency of subjected resistant strains can be helpful for decision makers to implement proper health policies in this direction.
PubMed: 30532606
DOI: 10.2147/AHMT.S180489 -
European Journal of Clinical... Sep 2016Vancomycin-resistant Enterococcus (VRE) is considered to be a major nosocomial pathogen that results in serious morbidity and mortality worldwide. Limited information is... (Meta-Analysis)
Meta-Analysis Review
Vancomycin-resistant Enterococcus (VRE) is considered to be a major nosocomial pathogen that results in serious morbidity and mortality worldwide. Limited information is available concerning the prevalence of VRE infections in Iran. We carried out a systematic search by using different electronic databases including: Medline (via PubMed), Embase, Web of Science, and the Iranian Database. Meta-analysis was performed using comprehensive meta-analysis software. The meta-analyses revealed that the prevalence of VRE infections was 9.4 % (95 % confidence interval [95 % CI] 7.3-12) among culture-positive cases for Enterococcus species. The prevalence of VRE in Iran is compared with the results of developed countries. The prevalence of VRE in Germany, the United Kingdom (UK), and Italy was 11.2 %, 8.5-12.5 %, and 9 % respectively. Additionally, the frequency of vancomycin resistance among E. faecalis isolates was higher than for E. faecium. The results of this study indicate that a comprehensive infection control strategy based on hand hygiene, educating the hospital staff members, providing clinical guidance and principles for the appropriate use of antibiotics, sanitizing the hospitals, contact precautions, and active surveillance systems on the basis of international criteria is urgently needed.
Topics: Enterococcus faecalis; Enterococcus faecium; Gram-Positive Bacterial Infections; Humans; Infection Control; Iran; Prevalence; Vancomycin-Resistant Enterococci
PubMed: 27344575
DOI: 10.1007/s10096-016-2702-0 -
Microbial Drug Resistance (Larchmont,... Aug 2021Several and studies demonstrated that adding a β-lactam to vancomycin (VAN) or daptomycin (DAP) can provide synergy against methicillin-resistant (MRSA). However,... (Meta-Analysis)
Meta-Analysis
Several and studies demonstrated that adding a β-lactam to vancomycin (VAN) or daptomycin (DAP) can provide synergy against methicillin-resistant (MRSA). However, the results from clinical studies were controversial. The objective of this systematic review and meta-analysis was to compare the efficacy and safety of using VAN or DAP plus a β-lactam (combination therapy) and using VAN or DAP alone (monotherapy) in MRSA bloodstream infections. We included randomized controlled trials and observational studies evaluating whether combination therapy can improve clinical and microbiological outcomes and safety compared to monotherapy with VAN or DAP in MRSA-related bacteremia. Literature search identified 3 randomized clinical trials and 10 observational studies involving at least 1,796 patients. There were no significant associations between the combination therapy and risk of mortality within 30 days (risk ratios [RRs], 1.10, 95% confidence interval [CI], 0.82-1.46), in-hospital mortality (RR, 0.59, 95% CI, 0.31-1.13) and mortality within 60-90 days (RR, 0.91, 95% CI, 0.64-1.29). There was also no evidence that there was a difference in length of hospital stay between the combination therapy and monotherapy (mean difference, -0.41 days, 95% CI, -3.41 to 2.59). However, compared with monotherapy, combination therapy seemed to have a shorter duration of bacteremia(mean difference, -1.06 days, 95% CI, -1.53 to -0.60), a lower risk of persistent bacteremia (RR, 0.63, 95% CI, 0.51-0.79) and a lower risk of bacteremia recurrence within 60-90 days (RR, 0.61, 95% CI, 0.40-0.92). There were no statistically significant differences in the total number of adverse events, including acute kidney injury (AKI) (RR, 1.52, 95% CI, 0.84-2.73), thrombocytopenia (RR, 1.13, 95% CI, 0.74-1.73), and diarrhea (RR, 1.36, 95% CI, 0.70-2.65), between patients with combination therapy and monotherapy. In subgroup analysis, when the analysis was limited to the studies comparing using DAP plus ceftaroline with monotherapy, we found that the former had a lower risk of mortality within 30 days. In addition, a subgroup analysis limited to randomized clinical trials showed that the combination therapy was associated with a higher risk of AKI compared with using VAN or DAP alone. Although adding a β-lactam to standard therapy seemed to experience a higher clearance compared with monotherapy in patients with MRSA bacteremia, the combination therapy did not increase survival benefits. Based on the available evidence, the combination therapy was not supported as the routine management of MRSA-related bacteremia, and both its harms and benefits should be taken into account.
Topics: Anti-Bacterial Agents; Bacteremia; Daptomycin; Drug Therapy, Combination; Humans; Length of Stay; Methicillin-Resistant Staphylococcus aureus; Observational Studies as Topic; Randomized Controlled Trials as Topic; Staphylococcal Infections; Vancomycin; beta-Lactams
PubMed: 33728980
DOI: 10.1089/mdr.2020.0350 -
Archives of Disease in Childhood Sep 2022Vancomycin is a recognised cause of drug-induced acute kidney injury (AKI).
INTRODUCTION
Vancomycin is a recognised cause of drug-induced acute kidney injury (AKI).
OBJECTIVE
The aim of this systematic review was to summarise the incidence of, and the risk factors for, vancomycin-associated AKI (v-AKI) in children.
DESIGN
A systematic search was performed in November 2020 on the search engines PubMed, Web of Science and Medline, using predefined search terms. The inclusion criteria were primary paediatric studies, intervention with vancomycin and studies that included AKI as an outcome. Study quality was assessed using the relevant Critical Appraisal Skills Programme checklist. The data are reported using descriptive statistics.
RESULTS
890 studies were identified and screened with 25 studies suitable for inclusion. A cohort of 12 730 patients with v-AKI were included and the incidence of v-AKI in children was found to be 11.8% (1.6%-27.2%). The median age of the cohort was 2.5 years (range 0-23) and 57% were male patients. Risk factors that increased the likelihood of v-AKI were concomitant use of nephrotoxic medications, increased trough concentrations and, to a lesser extent, increased dose, longer duration of treatment, impaired renal function and if the patient required paediatric intensive care.
CONCLUSIONS
The incidence of v-AKI in children is significant and methods to reduce this risk should be considered. Further prospective interventional studies to understand the mechanisms of nephrotoxicity from vancomycin are needed and targeting risk factors may make vancomycin administration safer.
PubMed: 35210220
DOI: 10.1136/archdischild-2021-323429 -
Therapeutic Drug Monitoring Jun 2020Studies comparing the clinical outcomes between vancomycin intermittent infusion (InI) and continuous infusion (CoI) treated patients are generally underpowered....
BACKGROUND
Studies comparing the clinical outcomes between vancomycin intermittent infusion (InI) and continuous infusion (CoI) treated patients are generally underpowered. Moreover, due to large differences in the design and efficacy end points in these studies, a meta-analysis of the currently available data is not feasible. Therefore, this systematic review aimed to compare the exposure variability and target attainment with vancomycin during InI and CoI.
PATIENTS AND METHODS
A literature search was performed, and clinical studies reporting on vancomycin-treated populations were selected. After exclusion of reviews, case reports, and articles not published in the English language, 505 articles were screened for reported data on vancomycin serum concentrations. A total of 34 studies were included in the review. Relative standard deviations reported in the included studies were assessed, and vancomycin serum concentration variability and target attainment were compared between vancomycin InI and CoI.
RESULTS
The variability in serum concentrations was significantly larger for InI than for CoI (relative standard deviations 46.5% and 32.1%, respectively; P = 0.001). Notably, variability appeared to be independent of the study population or design. Studies directly comparing target attainment between both modes of administration denoted higher and faster target attainment with CoI in all instances.
CONCLUSIONS
In conclusion, CoI was associated with lower variabilities in the serum concentration and favorable target attainment rates compared with InI. These findings are important because vancomycin exposure is considered a major predictor of the patients' clinical outcomes. However, the role of lower serum concentration variability and higher target attainment rates in achieving better clinical outcomes needs to be evaluated in patients treated with vancomycin CoI compared with InI.
Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Drug Administration Schedule; Drug Monitoring; Healthy Volunteers; Humans; Infusions, Intravenous; Intensive Care Units; Vancomycin
PubMed: 32432845
DOI: 10.1097/FTD.0000000000000755 -
Journal of Personalized Medicine Aug 2022several blood-based biomarkers have been proposed for predicting vancomycin-associated kidney injury (VIKI). However, no systematic analysis has compared their... (Review)
Review
Blood Biomarkers and Metabolomic Profiling for the Early Diagnosis of Vancomycin-Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis of Experimental Studies.
BACKGROUND
several blood-based biomarkers have been proposed for predicting vancomycin-associated kidney injury (VIKI). However, no systematic analysis has compared their prognostic value.
OBJECTIVE
this systematic review and meta-analysis was designed to investigate the role of blood biomarkers and metabolomic profiling as diagnostic and prognostic predictors in pre-clinical studies of VIKI.
METHODS
a systematic search of PubMed was conducted for relevant articles from January 2000 to May 2022. Animal studies that administered vancomycin and studied VIKI were eligible for inclusion. Clinical studies, reviews, and non-English literature were excluded. The primary outcome was to investigate the relationship between the extent of VIKI as measured by blood biomarkers and metabolomic profiling. Risk of bias was assessed with the CAMARADES checklist the SYRCLE's risk of bias tool. Standard meta-analysis methods (random-effects models) were used.
RESULTS
there were four studies for the same species, dosage, duration of vancomycin administration and measurement only for serum creatine and blood urea nitrogen in rats. A statistically significant increase was observed between serum creatinine in the vancomycin group compared to controls (pooled = 0.037; Standardized Mean Difference: 2.93; 95% CI: 0.17 to 5.69; I = 92.11%). Serum BUN levels were not significantly different between control and vancomycin groups (pooled = 0.11; SMD: 3.05; 95% CI: 0.69 to 6.8; I = 94.84%). We did not identify experimental studies using metabolomic analyses in animals with VIKI.
CONCLUSIONS
a total of four studies in rodents only described outcomes of kidney injury as defined by blood biomarkers. Blood biomarkers represented included serum creatinine and BUN. Novel blood biomarkers have not been explored.
PubMed: 36143182
DOI: 10.3390/jpm12091397 -
International Journal of Antimicrobial... Feb 2018Although the exposure-dependent efficacy thresholds of vancomycin have been probed, less is known about acute kidney injury (AKI) thresholds for this drug. Sensitive... (Review)
Review
BACKGROUND
Although the exposure-dependent efficacy thresholds of vancomycin have been probed, less is known about acute kidney injury (AKI) thresholds for this drug. Sensitive urinary biomarkers, such as kidney injury molecule 1 (KIM-1), have shown high sensitivity and specificity for vancomycin-associated AKI. The aims of the study were to determine if there were dose-response curves with urinary KIM-1, and to evaluate the impact of therapy duration and sex on observed relationships.
METHODS
A systematic review was conducted via PubMed/MEDLINE. Data were compiled from preclinical studies that reported individual subject data for urinary KIM-1 concentrations, vancomycin dose (mg/kg), duration of treatment, and sex. Sigmoidal Hill-type models were fit to the individual dose-response data.
RESULTS
A total of 15 studies were identified, 6 of which reported vancomycin dose and KIM-1 data. Of these, three included individual animal-level data suitable for analysis. For all pooled rats, increasing total daily vancomycin doses displayed a dose-response curve with urinary KIM-1 concentrations (50% maximal toxic response=130.4 mg/kg/day). Dose-response curves were shifted left for females vs. males (P = 0.05) and for long (i.e. ≥7 days) vs. short (i.e. <4 days) duration of vancomycin therapy (P=0.02).
CONCLUSIONS
The collective findings demonstrate a clear dose-response relationship between vancomycin dose and AKI. As these analyses focused exclusively on dose-response relationships, additional preclinical data are needed to more clearly define vancomycin exposures that predict the onset of AKI.
Topics: Acute Kidney Injury; Animals; Anti-Bacterial Agents; Dose-Response Relationship, Drug; Female; Hepatitis A Virus Cellular Receptor 1; Humans; Male; Rats; Vancomycin
PubMed: 28803934
DOI: 10.1016/j.ijantimicag.2017.08.012 -
Pharmaceutics Mar 2022This systematic review and meta-analysis compares the efficacy of daptomycin and vancomycin in adult patients with bacteremia by methicillin-resistant Staphylococcus... (Review)
Review
Efficacy and Safety of Daptomycin versus Vancomycin for Bacteremia Caused by Methicillin-Resistant Staphylococcus aureus with Vancomycin Minimum Inhibitory Concentration > 1 µg/mL: A Systematic Review and Meta-Analysis.
This systematic review and meta-analysis compares the efficacy of daptomycin and vancomycin in adult patients with bacteremia by methicillin-resistant Staphylococcus aureus (MRSA) with vancomycin minimum inhibitory concentration (MIC) > 1 µg/mL. We searched the PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov databases on 12 May 2020. All-cause mortality (primary outcome) and treatment success rates were compared and subgroups stratified by infection source risk level and method of vancomycin susceptibility testing were also analyzed. Seven studies (n = 907 patients) were included in this efficacy analysis. Compared with vancomycin, daptomycin treatment was associated with significantly lower mortality (six studies, odds ratio (OR) 0.53, 95% confidence interval (CI) 0.29−0.98) and higher treatment success (six studies, OR 2.20, 95% CI 1.63−2.96), which was consistent regardless of the vancomycin MIC test method used. For intermediate-risk sources, daptomycin was a factor increasing treatment success compared with vancomycin (OR 4.40, 95% CI 2.06−9.40), and it exhibited a trend toward a higher treatment success rate for high-risk sources. In conclusion, daptomycin should be considered for the treatment of bacteremia caused by MRSA with vancomycin MIC > 1 µg/mL, especially in patients with intermediate- and high-risk bacteremia sources.
PubMed: 35456548
DOI: 10.3390/pharmaceutics14040714 -
Antimicrobial Agents and Chemotherapy Aug 2022To systematically evaluate the relationships between vancomycin trough serum concentrations and clinical outcomes in children using meta-analysis. Several databases,... (Meta-Analysis)
Meta-Analysis
To systematically evaluate the relationships between vancomycin trough serum concentrations and clinical outcomes in children using meta-analysis. Several databases, including PubMed, Elsevier, Web of Science, EMBASE, Medline, clinicaltrials.gov, the Cochrane Library, and three Chinese databases (Wanfang Data, China National Knowledge Infrastructure, and SINOMED), were comprehensively searched to obtain research articles on vancomycin use in children from inception through December 2021. All studies were screened and evaluated using the Cochrane systematic review method. Then, the feature information was extracted for meta-analysis. The evaluated results included clinical efficacy, vancomycin-associated nephrotoxicity, hepatotoxicity, ototoxicity, mortality, and microbial clearance. A total of 35 studies involving 4820 children were included in the analysis. The meta-analysis showed that compared with children with vancomycin trough concentrations <10 μg/mL, those with vancomycin trough concentrations ≥10 μg/mL had a higher clinical efficacy rate [OR: 2.23, 95% CI: 1.29 to 3.84, = 0.004] and higher incidences of nephrotoxicity [OR: 2.76, 95% CI: 1.51 to 5.07, = 0.001], ototoxicity [OR: 1.87, 95% CI: 1.08 to 3.23, = 0.02] and microbial clearance [OR: 2.36, 95% CI: 1.53 to 3.64, = 0.0001]. All-cause mortality [OR: 1.07, 95% CI: 0.45 to 2.53, = 0.88] and hepatotoxicity [OR: 0.84, 95% CI: 0.46 to 1.53, = 0.57] were similar between the two groups. Subgroup analysis showed that compared with children with vancomycin trough concentrations of 10 to 15 μg/mL, those with vancomycin trough concentrations >15 μg/mL had a higher incidence of nephrotoxicity [OR: 2.64, 95% CI: 1.28 to 5.43, = 0.008], but there was no significant difference in clinical efficacy [OR: 0.85, 95% CI: 0.30 to 2.44, = 0.76]. A vancomycin trough concentration of 10 to 15 μg/mL can improve clinical efficacy in children. Additionally, avoidance of trough concentrations >15 μg/mL can reduce the incidence of adverse reactions.
Topics: Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Child; Humans; Ototoxicity; Renal Insufficiency; Retrospective Studies; Vancomycin
PubMed: 35862741
DOI: 10.1128/aac.00138-22 -
PharmacoEconomics Nov 2017Clostridium difficile infection (CDI) is associated with high management costs, particularly in recurrent cases. Fidaxomicin treatment results in lower recurrence rates... (Comparative Study)
Comparative Study Review
BACKGROUND AND OBJECTIVE
Clostridium difficile infection (CDI) is associated with high management costs, particularly in recurrent cases. Fidaxomicin treatment results in lower recurrence rates than vancomycin and metronidazole, but has higher acquisition costs in Europe and the USA. This systematic literature review summarises economic evaluations (EEs) of fidaxomicin, vancomycin and metronidazole for treatment of CDI.
METHODS
Electronic databases (MEDLINE, Embase, Cochrane Library) and conference proceedings (ISPOR, ECCMID, ICAAC and IDWeek) were searched for publications reporting EEs of fidaxomicin, vancomycin and/or metronidazole in the treatment of CDI. Reference bibliographies of identified manuscripts were also reviewed. Cost-effectiveness was evaluated according to the overall population of patients with CDI, as well as in subgroups with severe CDI or recurrent CDI, or those at higher risk of recurrence or mortality.
RESULTS
Overall, 27 relevant EEs, conducted from the perspective of 12 different countries, were identified. Fidaxomicin was cost-effective versus vancomycin and/or metronidazole in 14 of 24 EEs (58.3%), vancomycin was cost-effective versus fidaxomicin and/or metronidazole in five of 27 EEs (18.5%) and metronidazole was cost-effective versus fidaxomicin and/or vancomycin in two of 13 EEs (15.4%). Fidaxomicin was cost-effective versus vancomycin in most of the EEs evaluating specific patient subgroups. Key cost-effectiveness drivers were cure rate, recurrence rate, time horizon, drug costs and length and cost of hospitalisation.
CONCLUSIONS
In most EEs, fidaxomicin was demonstrated to be cost-effective versus metronidazole and vancomycin in patients with CDI. These results have relevance to clinical practice, given the high budgetary impact of managing CDI and increasing restrictions on healthcare budgets.
OTHER
This analysis was initiated and funded by Astellas Pharma Inc.
Topics: Aminoglycosides; Anti-Bacterial Agents; Clostridium Infections; Cost-Benefit Analysis; Drug Costs; Fidaxomicin; Hospitalization; Humans; Metronidazole; Recurrence; Vancomycin
PubMed: 28875314
DOI: 10.1007/s40273-017-0540-2