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Table 1 Characteristics of included studies for target trough evaluation

From: The monitoring of vancomycin: a systematic review and meta-analyses of area under the concentration-time curve-guided dosing and trough-guided dosing

Study Design of study Country Duration of study Age of patients Percentage of MRSA and source Definition of trough levels
Lodise 2009 [9] Retrospective America 2005–2006 ≥18
Mean ± SD: 55.8 ± 18.1
MRSA infection (30%):
Bloodstream, central nervous system, infective endocarditis, intra-abdominal, osteomyelitis, prophylaxis, respiratory tract, skin and soft tissue, urinary tract, unknown.
Highest
The highest initial trough levels within 96 h of initiation of therapy
Hermsen 2010 [18] Retrospective America 2005–2007 ≥19
Median (IQR):
Trough < 15 μg/mL 59 (43–75)
Trough ≥15 μg/mL 60 (44.5–70)
MRSA infection (100%):
Pneumonia, endocarditis, osteomyelitis
Mean
Trough levels calculated using the sum of each measured trough level multiplied by the number of days and divided by the total number of treatment days
Clemens 2011 [19] Retrospective America 2008–2009 ≥18
Mean ± SD: 52.3 ± 16.3
MRSA bacteremia (100%):
Skin or soft tissue/bone, intravascular catheter, respiratory, endocarditis, endovascular, abdominal, unknown.
Steady-state
The first serum concentration collected ≤30 min before a scheduled dose after completing ≥24 h of vancomycin therapy
Kullar 2011 [20] Retrospective America 2005–2010 45–64
Median (IQR):
Success 53 (45–64)
Failure 54 (46–61)
MRSA bacteremia (100%):
Skin/wound, catheter-related, endocarditis, pneumonia, bone and joint, deep abscess, multiple sites, other.
Steady-state
Steady-state when available from clinical data. (e.g, immediately before the fourth dose)
Cano 2012 [26] Retrospective America 2006–2007 58.5 ± 17.2
Mean ± SD: 58.5 ± 17.2
Percentage of MRSA is not available:
Hospital-acquired pneumonia, ventilator-associated pneumonia, health care–associated pneumonia
Highest
Highest trough levels collected within 96 h of therapy
Horey 2012 [27] Retrospective America 2006–2008 ≥18
Mean ± SD: 67.4 ± 12.5
Percentage of MRSA is not available:
Empiric, skin and soft tissue, bone and joint, pneumonia, urinary tract infection, bacteremia/endocarditis, miscellaneous
Average
The average levels were calculated by first multiplying each trough level by the number of days at that concentration; next, these values, from the total duration of therapy, were added. The sum was then divided by the total number of days of vancomycin exposure to produce a clinical picture of total exposure to vancomycin.
Prabaker 2012 [28] Retrospective America 2005–2007 Median 59 or 61 in each group Percentage of MRSA is not available:
Skin/soft tissue/bone infection, pneumonia, bacteremia, other.
Mean
Trough levels drawn 30–60 min prior to the fourth dose, and again in 5–7 days or with any large change in renal function
Casapao 2013 [21] Retrospective America 2004–2012 ≥18
Mean ± SD: 57 ± 15.4
MRSA bacteremia (100%):
Infective endocarditis, pneumonia, intravenous catheter-related infection, bone and joint infection, skin and soft tissue infection, unknown.
Initial
(No detail information is available.)
Fujii 2013 [29] Retrospective Japan 2011 > 18
Median (range), SD: 64 (21–88), 14.2
Percentage of MRSA is not available. Highest
Trough levels determined 3 days after the initiation of vancomycin therapy
Ley 2013 [30] Retrospective America 2006–2010 ≥18
Mean ± SD: 50 ± 22.6
Percentage of MRSA is not available:
Trauma.
Trough levels drawn 1 h prior to the subsequent dose
Barriere 2014 [31] Retrospective 38 countries 2005–2007 ≥18
Mean ± SD: 64.7 ± 16.2
MRSA pneumonia (78%):
S. aureus nosocomial pneumonia, multilobar pneumonia, bacteremia.
Median
(No detail information is available.)
Ghosh 2014 [22] Retrospective Australia 2006–2012 > 18
Median (range):
64.6 (22–95)
MRSA bacteremia (100%):
Line-related bacteremia, bone and joint, skin and soft tissue infections, deep abscess, infective endocarditis, pneumonia, abdominal, non-endocarditis vascular, other, no identified focus.
Steady-state
Trough levels obtained a minimum of 12 h after the last dose
Song 2015 [23] Prospective Korea 2010–2012 ≥18
Median (IQR):
67 (53–75)
MRSA bacteremia (100%):
Central venous catheter, bone and joint, skin and soft tissue, deep tissue abscess, lower respiratory tract, endovascular infection, urinary tract, intra-abdominal, unknown, high-risk source.
Initial
(No detail information is available.)
Hammoud 2016 [33] Retrospective America 2011–2012 > 18
Mean: 56
MRSA infection (13%):
Skin and soft tissue infection, pneumonia, osteomyelitis, pelvic/abdominal infection
Mean
Mean levels calculated based on the theoretical number of days at various troughs for a specific patient
Hirano 2016 [34] Retrospective Japan 2007–2014 > 18
Mean ± SD: 68.2 ± 15.8
MRSA infection (100%):
Respiratory, skin and soft tissue, bacteremia, Central nervous, Intra-abdominal, urinary tract, mediastinal, bone and joint.
Steady-state
Trough levels defined as those determined after the fifth dose or on day 3 after the initiation of therapy
Obara 2016 [32] Prospective Brazil 2013–2014 > 18
Median (IQR): Trough 15–20 μg/mL 64.5 (52.3–79.5)
Trough ≥20 μg/mL 55.5 (40–70.8)
Percentage of MRSA is not available. Initial
Initial levels obtained immediately before vancomycin fourth dose
Chuma 2018 [35] Retrospective Japan 2005–2015 ≥18
Median (IQR):
67 (55–75)
MRSA infection (34%):
Abdominal, blood stream catheter related, endocarditis, meningitis, soft tissue, pulmonary, urinary.
Initial
Initial trough levels measured within 4 days after the beginning of administration
Fu 2018 [24] Retrospective Taiwan 2013–2016 ≥20
Mean ± SD: 69 ± 14.8
MRSA bacteremia (100%):
Bone and joint, catheter-related, endocarditis, pneumonia, surgical wound or skin and soft tissue, unknown.
Mean
Pre-dialysis trough levels
Huang 2018 [36] Retrospective China 2007–2014 ≥80
Mean ± SD: 85 ± 3.9
MRSA infection (24%) Trough levels obtained within 72 h of commencing therapy, after administering a minimum of three doses
Mogle 2018 [25] Retrospective America 2016–2018 ≥18
Mean ± SD: 50 ± 17.6
MRSA bacteremia (100%):
Skin and soft tissue, catheter related/endovascular, bone and joint, urinary tract, pneumonia, presence of endocarditis, unknown.
Steady-state
consecutive steady-state post-distributional serum concentrations obtained within 96 h of therapy
Park 2018 [37] Retrospective Korea 2013 ≥18
Median (IQR):
58 (45–59)
Percentage of MRSA is not available:
Pneumonia, sepsis/Septic shock, skin/skin structure infection, bacteremia, other.
Mean
Trough levels measured in blood samples collected just prior to administration of the next dose
Shime 2018 [38] Prospective Japan 2014–2015 60–78
Median (IQR):
71 (60–78)
MRSA infection (100%):
Bacteremia, lung skin and soft tissue, bone and joint, other.
Highest
(No detail information is available.)
de Almeida 2019 [39] Prospective Brazil 2017–2018 ≥18
Median (IQR):
55.9 (40.6–66.8)
MRSA infection (6.1%):
Skin and soft tissue, surgical site, pulmonary, bone, catheter, central nervous system, kidney, others, undetermined.
Steady-state
Trough levels measured at the third (after the fourth or fifth dose, corresponding to the steady-state)
  1. N/A not available