Evaluating the Nephrotoxicity of Area-under-the-Curve-Based Dosing of Vancomycin with Concomitant Antipseudomonal Beta-Lactam Antibiotics: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. General Guidelines
2.2. Database Searches and Identification of Eligible Papers
2.3. Inclusion and Exclusion Criteria
2.4. Methodological Quality Appraisal
2.5. Data Extraction and Management
2.6. Primary and Secondary Outcomes
2.7. Statistical Analysis
3. Results
3.1. Study Selection
3.2. Methodological Quality of the Included Studies
3.3. Primary Outcome: Risk of AKI in Patients Who Received Vancomycin + Piperacillin/Tazobactam under AUC-Based Dosing
3.4. Secondary Outcomes: Risk of AKI and Daily Vancomycin Dose in Patients Who Received Vancomycin + Piperacillin/Tazobactam under Different Vancomycin Dosing
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author, Year, Country, Reference | Okada, 2021, Japan, [14] | Muklewicz, 2021, USA, [15] | Kiley, 2022, USA, [16] | Karas, 2022, USA, [17] |
---|---|---|---|---|
Study Design | Retrospective, single hospital | Retrospective, 3 hospitals | Retrospective, single hospital | Retrospective, 3 hospitals |
Period | 04/2010–03/2020 | case: 04/2019–07/2019; control: 08/2019–03/2020 | 10/2019–09/2020 | 01/2015–06/2021 |
Sample size | VPT: 61, C a: 42 | VPT: 118, C b: 210; AUC-based: 118, trough-based: 118 | VPT: 331, C c: 104 | AUC-based: 150, trough-based: 150 |
AUC calculation method | Bayesian model | Bayesian model | Bayesian model or Sawchuk–Zaske method | Two-sample AUC or Bayesian model |
Actual AUC level | VPT: median 452; C a: median 427.7 | AUC mean 445.7 | VPT: mean 503; C c: mean 495, | NA |
Duration of combination therapy | VPT: median 5 days, C a: median 4 days | VPT: mean 6.2 days, C b: mean 4.8 days; AUC-based: mean 4.0 days, trough-based: mean 4.9 days | VPT: median 4 days, C c: median 4 days | AUC-based: mean 5.18 days; trough-based: mean 5.11 days |
AKI definition | KDIGO | IDSA/AKIN/RIFLE | RIFLE | IDSA/KDIGO/RIFLE |
Other outcomes examined | AUC cutoff: 600 | 30 days readmission, in-hospital mortality | AUC cutoff: 550 | No |
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Chiu, C.-Y.; Sarwal, A. Evaluating the Nephrotoxicity of Area-under-the-Curve-Based Dosing of Vancomycin with Concomitant Antipseudomonal Beta-Lactam Antibiotics: A Systematic Review and Meta-Analysis. Medicina 2023, 59, 691. https://doi.org/10.3390/medicina59040691
Chiu C-Y, Sarwal A. Evaluating the Nephrotoxicity of Area-under-the-Curve-Based Dosing of Vancomycin with Concomitant Antipseudomonal Beta-Lactam Antibiotics: A Systematic Review and Meta-Analysis. Medicina. 2023; 59(4):691. https://doi.org/10.3390/medicina59040691
Chicago/Turabian StyleChiu, Chia-Yu, and Amara Sarwal. 2023. "Evaluating the Nephrotoxicity of Area-under-the-Curve-Based Dosing of Vancomycin with Concomitant Antipseudomonal Beta-Lactam Antibiotics: A Systematic Review and Meta-Analysis" Medicina 59, no. 4: 691. https://doi.org/10.3390/medicina59040691