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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 -
International Journal of Antimicrobial... Dec 2023Vancomycin is used to treat Gram-positive infections in critically ill adults. For vancomycin administered by continuous infusion (CI), various target ranges have been... (Review)
Review
OBJECTIVES
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.
METHODS
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.
RESULTS
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).
CONCLUSIONS
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.
Topics: Humans; Adult; Vancomycin; Anti-Bacterial Agents; Critical Illness; Acute Kidney Injury; Treatment Outcome; Retrospective Studies
PubMed: 37839714
DOI: 10.1016/j.ijantimicag.2023.107005 -
Infection and Drug Resistance 2020To provide a comprehensive review of vancomycin dosing in patients with hematologic malignancies or neutropenia. (Review)
Review
OBJECTIVE
To provide a comprehensive review of vancomycin dosing in patients with hematologic malignancies or neutropenia.
METHODS
PubMed, Embase and the Cochrane Library were searched through April 2, 2020. Original studies relevant to vancomycin dosing regimen in adults with hematologic malignancies or neutropenia were included. No restriction was applied in study design and language. A descriptive analysis was performed.
RESULTS
Twenty-three studies were included eventually, of which eighteen were case series studies, four were cohort studies and another one was a randomized controlled trial. Five case series studies made a clinical audit of conventional vancomycin dosing in patients with malignancies or neutropenia, showing that the proportion of patients with sub-therapeutic trough levels remained high, ranging from 32% to 88%. Seven case series studies and four cohort studies demonstrated that vancomycin clearance (CLva) tended to be higher in patients with hematologic malignancies or neutropenia, whereas volume of distribution (V) seemed to be comparable to the control group. Five studies proposed individualized initial dosing regimen per the pharmacokinetic changes; however, no prospective validation has been conducted in clinical setting. Additionally, four case series studies suggested that the correlation between vancomycin clearance and estimated creatinine clearance was relatively poor, bringing a great challenge to proper dosing strategy. A randomized controlled trial stated that therapeutic drug monitoring (TDM) of vancomycin could decrease the incidence of nephrotoxicity in immunocompromised febrile patients with hematologic malignancies.
CONCLUSION
The available evidence indicates that conventional vancomycin dosing leads to suboptimal concentration in patients with hematologic malignancy or neutropenia. TDM accompanied by pharmacokinetic interpretation can decrease the risk of nephrotoxicity. The individualization of the initial dosing regimen and mechanisms of augmented clearance require further research.
PubMed: 32606830
DOI: 10.2147/IDR.S239095 -
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 -
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 -
Biology of Sex Differences May 2021Vancomycin-resistant enterococci (VRE) have emerged in the healthcare setting worldwide. Infections with these pathogens, i.e., bloodstream infections (BSI), are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Vancomycin-resistant enterococci (VRE) have emerged in the healthcare setting worldwide. Infections with these pathogens, i.e., bloodstream infections (BSI), are accompanied with an impaired patient outcome. Diverse factors comprising patient characteristics, therapeutic strategies, and infection control measures are positively or negatively associated with VRE BSI occurrence. However, whether sex-specific differences influence the frequency of VRE BSI is yet unknown. The aim of this systematic review was to comprehensively summarize and analyze sex prevalence in VRE BSI patients.
MAIN TEXT
A systematic search for relevant articles was conducted in PubMed and Web of Science. After screening for eligibility, data extraction from included articles and risk of bias assessment were processed. The prevalence of male/female sex in VRE BSI patients and 95% CI were calculated for each study and summarized as pooled estimated effect. In total, nine articles met the inclusion criteria. Risk of bias assessment resulted in low (six studies) to moderate bias (three studies). The pooled prevalence of male patients suffering from VRE BSI was 59% resulting in a 1.4 male/female prevalence ratio.
CONCLUSIONS
Current literature suggests sex differences with male preference (59%) in the distribution of VRE BSI cases. Further primary studies should address the question of male-specific factors favoring the enhanced frequency of VRE BSI.
Topics: Anti-Bacterial Agents; Bacteremia; Female; Gram-Positive Bacterial Infections; Humans; Male; Sex Characteristics; Vancomycin-Resistant Enterococci
PubMed: 34001270
DOI: 10.1186/s13293-021-00380-5 -
Antimicrobial Resistance and Infection... Aug 2023Vancomycin-resistant Enterococci (VRE) infections are recurrently reported in different parts of India in the last two decades. However, an up-to-date, countrywide... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Vancomycin-resistant Enterococci (VRE) infections are recurrently reported in different parts of India in the last two decades. However, an up-to-date, countrywide information concerning the prevalence and the rate of VRE in India is limited and hence this study aimed to estimate the pooled prevalence of VRE in India.
METHODS
A literature search was performed using various databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout. Cross-sectional studies reporting the prevalence of VRE in India from human samples whereby at least two Enterococci were isolated between 1 January 2000 and 31 December 2022 were sought for inclusion. Data were extracted and analysed using Microsoft Excel and Comprehensive Meta-analysis version 4, respectively.
RESULTS
Nineteen studies were included in the analyses. A collective total of 3683 Enterococci isolates were examined, of which 368 were VRE strains. The pooled prevalence of VRE in India was calculated at 12.4% (95% CI: 8.6-17.5; Q = 189.69; I = 90.51%; p = < 0.001). E. faecalis was the most frequently isolated species (1450 [39.37%]) followed by E. faecium (724 [19.66%]). Amongst the VRE strains, E. faecium was the most prevalent (214 [58.15%]) followed by E. faecalis (134 [36.41%]). An upsurge in the rate of VRE infections was observed in India over time: VRE prevalence was estimated at 4.8% between 2000 and 2010 and 14.1% between 2011 and 2020.
CONCLUSION
This study presents the most up-to-date information on the rate of VRE infections in India. Though lower than the findings for some less developed countries, VRE prevalence in India is notable and on the rise.
Topics: Humans; Vancomycin-Resistant Enterococci; Cross-Sectional Studies; Prevalence; India; Databases, Factual
PubMed: 37605268
DOI: 10.1186/s13756-023-01287-z -
Iranian Journal of Public Health Dec 2023Meat and meat products are introduced as one of the frequent sources of . We aimed to determine the prevalence and antibiotic resistance of isolates in meat and meat... (Review)
Review
BACKGROUND
Meat and meat products are introduced as one of the frequent sources of . We aimed to determine the prevalence and antibiotic resistance of isolates in meat and meat products using a systematic review and meta-analysis.
METHODS
A literature search was performed in the primary international and bibliographic databases such as MEDLINE (PubMed), Cochrane Library, Embase, Scopus, and Web of Science to achieve all articles related to the prevalence and antibiotic resistance rates from 2007 to 2022.
RESULTS
The 278 retrieved articles were reduced to 54 worldwide eligible studies after screening and matching inclusion/exclusion criteria. was examined in different types of samples and its resistance to 10 antibiotics. The pooled prevalence of was 3.4% in all samples. pooled prevalence was detected in fish, poultry, and red meat groups with 6.9%, 5.2%, and 3.2%, respectively. Regarding antibiotic resistance, the highest pooled prevalence was for ciprofloxacin (86.6%), followed by clindamycin (42.6%) and erythromycin (34%). The lowest pooled prevalence was observed in metronidazole (7.6%), vancomycin (6.6%), and chloramphenicol (6%).
CONCLUSION
Low resistance was found to commonly used drugs for infection (CDI) treatment. Since each antibiotic can be predisposing cause for CDI development, this finding possibly will be warning from a One Health viewpoint about the misuse of antibiotics in the chain of farm to fork including agriculture, animal husbandry and the food industry and also their injudicious use in medicine.
PubMed: 38435778
DOI: 10.18502/ijph.v52i12.14313 -
Journal of Global Antimicrobial... Jun 2022The aim of this study was to determine the pooled estimate of Staphylococcus aureus and coagulase negative staphylococci and their antimicrobial-resistance in patients... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aim of this study was to determine the pooled estimate of Staphylococcus aureus and coagulase negative staphylococci and their antimicrobial-resistance in patients with wound infection.
METHODS
Literature searches were carried out in the electronic biomedical databases and indexing services such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science and Google Scholar. Original records of research articles, available online from 1988 to March 2020, addressing the rates and antimicrobial-resistance pattern of staphylococcus aureus (S. aureus) and coagulase negative staphylococci (CoNS) in patients with wound infection were identified and screened. Endnote citation manager software version X9 for windows was utilized to collect and organize search outcomes and for removal of duplicate articles. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 14.0 software for the outcome measures analyses and subgrouping.
RESULTS
The electronic databases search yielded 378 studies, of which 39 met predefined inclusion criteria and included in the final analyses. The pooled estimate of wound infection was 36% [95% CI: 23-50%) for S. aureus and 12% [95% CI: 9-14%) for CoNS. S. aureus exhibited a higher rate of resistance to penicillin (84%), ampicillin (83%), amoxicillin (67%), methicillin (50%), cotrimoxazole (50%), tetracycline (61%), doxycycline (58%), chloramphenicol (49%) and erythromycin (45%). However, relative lower resistant rate was observed to Augmentin (amoxicillin-clavulanic acid) (35%), gentamicin (33%), norfloxacin (23%), ciprofloxacin (26%), ceftriaxone (36%), vancomycin (29%) and clindamycin (40%). Similarly, for CoNS there was high resistance to methicillin, 52% [95% CI: 26-78%]) and other antibiotics, but lower resistance to clindamycin, 15% [95% CI: 6-24]) and vancomycin, 22% [95% CI: 2-41%]). Ceftriaxone resistance was observed with prevalence of 36% [95% CI: 21-50%] for S. aureus and 42% [95% CI: 29-55%] for CoNS.
CONCLUSION
There was high resistance of staphylococci bacterial species to commonly used antimicrobials in the clinical settings in Ethiopia. It is a high time to implement multitude strategies to contain the threat. Further research focusing on factors promoting resistance and the effect of resistance on treatment outcome studies on these virulent organisms are warranted.
Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Clindamycin; Coagulase; Ethiopia; Humans; Methicillin; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Vancomycin; Wound Infection
PubMed: 34801740
DOI: 10.1016/j.jgar.2021.10.025 -
Drug, Healthcare and Patient Safety 2023The aim of this systematic review of randomized clinical trials (RCTs) was to examine the efficacy, safety, and tolerability of vancomycin for treatment of recurrent... (Review)
Review
INTRODUCTION
The aim of this systematic review of randomized clinical trials (RCTs) was to examine the efficacy, safety, and tolerability of vancomycin for treatment of recurrent infection (rCDI).
METHODS
The PubMed database was searched from inception to August 23, 2022. An initial screening was performed followed by a full-text evaluation of the papers. Inclusion criteria were RCTs investigating vancomycin for treatment of rCDI.
RESULTS
A total of six studies and 269 patients were included in the review. Three studies used a fixed dose regimen of vancomycin, one study used pulse regimen, one study used a taper-and-pulse regimen, and one study used a taper-and-pulse regimen for the participants with two or more recurrences. The resolution of infection varied from 19% to 58.3% in five of six studies reporting this as an outcome. Four out of six studies reported new episodes of rCDI as an intervention outcome, in those studies 50-63% of participants experienced rCDI. Regarding the safety and tolerability of vancomycin treatment for rCDI, one study described several adverse events regarding gastrointestinal discomfort along with fatigue and skin rash. There were no records of serious adverse events in the included studies.
CONCLUSION
While oral vancomycin is mostly safe and well tolerated in the RCTs reviewed here, the efficacy for treating rCDI varies greatly from 19-58.3%, and 50-63% of participants experienced new episodes of rCDI.
PubMed: 36974197
DOI: 10.2147/DHPS.S348501