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Meta-Analysis
. 2016 Jan 5;11(1):e0146224.
doi: 10.1371/journal.pone.0146224. eCollection 2016.

Association between the AUC0-24/MIC Ratio of Vancomycin and Its Clinical Effectiveness: A Systematic Review and Meta-Analysis

Peng Men  1   2 , Hui-Bo Li  1   2 , Suo-Di Zhai  1 , Rong-Sheng Zhao  1
Affiliations
Meta-Analysis

Association between the AUC0-24/MIC Ratio of Vancomycin and Its Clinical Effectiveness: A Systematic Review and Meta-Analysis

Peng Men et al. PLoS One. .

Abstract

Background: A target AUC0-24/MIC ratio of 400 has been associated with its clinical success when treating Staphylococcus aureus infections but is not currently supported by state-of-the-art evidence-based research.

Objective: This current systematic review aimed to evaluate the available evidence for the association between the AUC0-24/MIC ratio of vancomycin and its clinical effectiveness on hospitalized patients and to confirm the existing target value of 400.

Methods: PubMed, Embase, Web of Sciences, the Cochrane Library and two Chinese literature databases (CNKI, CBM) were systematically searched. Manual searching was also applied. Both RCTs and observational studies comparing the clinical outcomes of high AUC0-24/MIC groups versus low AUC0-24/MIC groups were eligible. Two reviewers independently extracted the data. The primary outcomes were mortality and infection treatment failure. Risk ratios (RRs) with 95% confidence intervals (95%CIs) were calculated.

Results: No RCTs were retrieved. Nine cohort studies were included in the meta-analysis. Mortality rates were significantly lower in high AUC0-24/MIC groups (RR = 0.47, 95%CI = 0.31-0.70, p<0.001). The rates of infection treatment failure were also significantly lower in high AUC/MIC groups and were consistent after correcting for heterogeneity (RR = 0.39, 95%CI = 0.28-0.55, p = 0.001). Subgroup analyses showed that results were consistent whether MIC values were determined by broth microdilution (BMD) method or Etest method. In studies using the BMD method, breakpoints of AUC0-24/MIC all fell within 85% to 115% of 400.

Conclusions: This meta-analysis demonstrated that achieving a high AUC0-24/MIC of vancomycin could significantly decrease mortality rates by 53% and rates of infection treatment failure by 61%, with 400 being a reasonable target.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart depicting the selection process of studies included in the meta-analysis.
Fig 2
Fig 2. Risk ratios of all-cause mortality rates: high versus low AUC0-24/MIC ratio.
Test of all-cause mortality rates for overall effect: Z = 3.72, P<0.001; test of all-cause mortality rates in Etest Study subgroup for overall effect: Z = 2.12, P = 0.034; test of all-cause mortality rates in BMD Study subgroup for overall effect: Z = 3.12, P = 0.002.
Fig 3
Fig 3. Risk ratios of rates of infection treatment failure: high versus low AUC0-24/MIC ratio.
Test of rates of infection treatment failure for overall effect: Z = 3.34, P = 0.001.
Fig 4
Fig 4. Risk ratios of rates of infection treatment failure: high versus low AUC0-24/MIC ratio (Kullar’s study was excluded).
Test of rates of infection treatment failure for overall effect: Z = 5.55, P<0.001.
See this image and copyright information in PMC

References

    1. Vandecasteele SJ, De Vriese AS, Tacconelli E. The pharmacokinetics and pharmacodynamics of vancomycin in clinical practice: Evidence and uncertainties. J Antimicrob Chemother. 2013;68(4): 743–748. 10.1093/jac/dks495 - DOI - PubMed
    1. Holland TL, Fowler VG Jr. Vancomycin minimum inhibitory concentration and outcome in patients with Staphylococcus aureus bacteremia: pearl or pellet? J Infect Dis. 2011;204(3): 329–331. 10.1093/infdis/jir275 - DOI - PubMed
    1. Ye ZK, Tang HL, Zhai SD. Benefits of therapeutic drug monitoring of vancomycin: a systematic review and meta-analysis. PLoS One. 2013;8(10): e77169 10.1371/journal.pone.0077169 - DOI - PMC - PubMed
    1. Rybak MJ. The pharmacokinetic and pharmacodynamic properties of vancomycin. Clin Infect Dis. 2006;42 Suppl 1: S35–S39. - PubMed
    1. Rybak M, Lomaestro B, Rotschafer JC, Moellering R Jr., Craig W, Billeter M, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2009;66(1): 82–98. 10.2146/ajhp080434 - DOI - PubMed

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