Evidence map›Paper›PMID 23165462›Full record

SynthesisAntimicrobial agents and chemotherapy2013

Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter.

S J van Hal, D L Paterson, T P Lodise

2 registry-linked trialsOpen access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Antimicrobial agents and chemotherapy, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 265 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
265citing papers in PubMed, 7 pooled it
18.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03586362 completednot on this mapstarted 2018, after this paper: background citation

Vancomycin De-escalation Therapy in Patients With Pneumonia and Negative MRSA Nasal Swab

TypeobservationalSponsorCAMC Health SystemRan2018 to 2023Enrolled278ConditionsPneumonia
NCT06272994 nacompletednot on this mapstarted 2024, after this paper: background citation

Swab Testing to Optimize Pneumonia Treatment With Empiric Vancomycin (STOP-Vanc)

TypeinterventionalSponsorVanderbilt University Medical CenterRan2024 to 2025Enrolled277ConditionsCommunity-acquired PneumoniaArmsMRSA Nasal Swab PCR
3 · Its place in the literature

Who cites it

265 citing papers in PubMed, 7 syntheses or guidelines pooled it, 618 citations in OpenAlex.

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205 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 3 institutions in 2 countries.

S J van HalDepartment of Microbiology & Infectious Diseases, Royal Prince Alfred Hospital, Sydney, Australia. Sebastian.vanhal@sswahs.nsw.gov.au
D L Paterson
T P Lodise
Albany College of Pharmacy and Health Sciences · USUniversity of Queensland · AUWestern Sydney University · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

In an effort to maximize outcomes, recent expert guidelines recommend more-intensive vancomycin dosing schedules to maintain vancomycin troughs between 15 and 20 mg/liter. The widespread use of these more-intensive regimens has been associated with an increase in vancomycin-induced nephrotoxicity reports. The purpose of this systematic literature review is to determine the nephrotoxicity potential of maintaining higher troughs in clinical practice. All studies pertaining to vancomycin-induced nephrotoxicity between 1996 and April 2012 were identified from PubMed, Embase, Cochrane Controlled Trial Registry, and Medline databases and analyzed according to Cochrane guidelines. Of the initial 240 studies identified, 38 were reviewed, and 15 studies met the inclusion criteria. Overall, higher troughs (≥ 15 mg/liter) were associated with increased odds of nephrotoxicity (odds ratio [OR], 2.67; 95% confidence interval [CI], 1.95 to 3.65) relative to lower troughs of <15 mg/liter. The relationship between a trough of ≥ 15 mg/liter and nephrotoxicity persisted when the analysis was restricted to studies that examined only initial trough concentrations (OR, 3.12; 95% CI, 1.81 to 5.37). The relationship between troughs of ≥ 15 mg/liter and nephrotoxicity persisted after adjustment for covariates known to independently increase the risk of a nephrotoxicity event. An incremental increase in nephrotoxicity was also observed with longer durations of vancomycin administration. Vancomycin-induced nephrotoxicity was reversible in the majority of cases, with short-term dialysis required only in 3% of nephrotoxic episodes. The collective literature indicates that an exposure-nephrotoxicity relationship for vancomycin exists. The probability of a nephrotoxic event increased as a function of the trough concentration and duration of therapy.

Indexed as

Acute Kidney InjuryAnti-Bacterial AgentsHumansKidneyRenal DialysisVancomycinAnti-Bacterial AgentsVancomycin

Identifiers

PMID23165462
PMCPMC3553731
OpenAlexW2011312924

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.