Evidence map›Paper›PMID 27686168›Full record

ArticleBMC research notes2016

The safety and efficacy of high versus low vancomycin trough levels in the treatment of patients with infections caused by methicillin-resistant Staphylococcus aureus: a meta-analysis.

Sasima Tongsai, Pornpan Koomanachai

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC research notes, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06272994 (Swab Testing to Optimize Pneumonia Treatment With Empiric Vancomycin), which is not on this map. Cited by 26 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 4 pooled it
–field-weighted citation impact
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.

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

26 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Pharmacokinetics of Vancomycin in Critically Ill Children: A Systematic Review.European journal of drug metabolism and pharmacokinetics · 2022
    Pooled it
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  6. Therapeutic drug monitoring in patients treated with vancomycin: a single center, prospective, observational, real-world study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025
    Observational
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  18. Observational
  19. Continuous Infusion Vancomycin in Pediatric Patients: A Critical Review of the Evidence.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2020
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors.

Sasima TongsaiClinical Epidemiology Unit, Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand. sasima.ton@mahidol.ac.th.
Pornpan KoomanachaiDivision of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecent guidelines have recommended vancomycin trough levels of 15-20 mg/L for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, high trough levels may increase risk of nephrotoxicity and mortality, and high vancomycin trough levels have not been well studied. This study was designed to combine safety and efficacy results from independent studies and to compare between high and low vancomycin trough levels in the treatment of MRSA-infected patients using meta-analysis.

methodsFrom 19 eligible studies, 9 studies were included in meta-analysis to compare clinical success between high and low vancomycin trough levels, while 10 and 11 studies met criteria for comparing trough levels and nephrotoxicity and trough levels and mortality, respectively. The PubMed/Medline, Web of Science, and Scopus databases, and hand searching were used to identify eligible studies dated up to March 2016. Of 2344 subjects with MRSA infection, 1036 were assigned to trough levels ≥15 mg/L and 1308 to trough levels <15 mg/L.

resultsHigh vancomycin trough levels were found to be associated with risk of nephrotoxicity (odds ratio [OR] 2.14, 95 % confidence interval [CI] 1.42-3.23 and adjusted OR 3.33, 95 % CI 1.91-5.79). There was no evidence of difference between high and low vancomycin trough levels for mortality (OR; 1.09; 95 % CI 0.75-1.60) or clinical success (OR 1.07; 95 % CI 0.68-1.68).

conclusionIn this study, high vancomycin trough levels were identified as an independent factor associated with risk of nephrotoxicity in MRSA-infected patients. Association between vancomycin trough levels and both adverse effects and clinical outcomes requires further study.

Indexed as

Clinical successMeta-analysisMethicillin-resistant Staphylococcus aureusMortalityNephrotoxicityVancomycin trough levels

Identifiers

PMID27686168
PMCPMC5041442

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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.