Table 1 Summarized characteristics of the eligible studies in the meta-analysis
Author | Country | Study period | Patient characteristic | Study design (No. of subjects) | Timing of vancomycin trough level measurement | Duration of vancomycin therapy |
|---|---|---|---|---|---|---|
Michigan, USA | 2004–2012 | Patients with MRSA IE infections treated with VAN for ≥3 days, and who had initial VAN trough levels evaluated | Retrospective cohort study (n = 128) | Initial | NA | |
Zelenitsky et al. [67] | Canada | 2002–2007 | Patients age ≥18 years treated with VAN for MRSA-associated septic shock | Retrospective study (n = 34) | Initial |  |
Tadros et al. [68] | Canada | 2011 | Patients aged ≥18 years with MRSA pneumonia infections treated with VAN, and who had at least one initial VAN trough level measurement | Prospective surveillance study (n = 161) | Average | NA |
Arshad et al. [69] | USA | 2005–2007 | Patients with MRSA bacteraemia treated with VAN, while patients with acute renal failure on admission, dialysis and those not at steady-state after third dose of VAN were excluded | Retrospective study (n = 104) | Initial and average | NA |
Leu et al. [34] | Taiwan | 2009–2011 | Patients with MRSA infections (most infections were pneumonia, wound infection, or bacteremia) treated with VAN for ≥3 days, and who had at least one VAN trough concentration measurement | Non-randomized comparative study (n = 76) | Not stated | NA |
Kullar et al. [17] | Michigan, USA | 2005–2010 | Adult patients with complicated MRSAB infections treated with VAN for ≥72 h | Retrospective quasi-experimental study (n = 200) | Initial | Median durations of VAN were 13 and 8.5 days for patients with trough levels <15 and ≥15 mg/L, respectively |
Rojas et al. [38] | Spain | 2005–2009 | Adult patients with MRSA bloodstream infections treated with VAN, and who had at least one VAN trough concentration measurement | Retrospective cohort study (n = 104) | Average | Median duration of VAN was 14 days (range 8–19) and 42.3% of patients received VAN for >14 days |
Wunderink et al. [70] | USA | 2004–2010 | Patients aged ≥18 years with MRSA nosocomial pneumonia who had an expected survival of ≥72 h | Multicenter prospective study, since there was no randomization with respect to VAN trough levels (n = 333) | Average (Median) | NA |
Bosso et al. [71] | South Carolina, USA | 2008–2010 | Patients aged ≥18 years with MRSA infections treated with VAN for ≥72 h, and who had at least one VAN trough concentration measured 2–4 days into therapy | Multicenter prospective observational study (n = 288) | Initial single trough level measured 2–4 days into therapy; in case of multiple measurements, the average trough level was calculated | Average length of VAN therapy was 9 days (median 7.5) |
Chan et al. [72] | USA | 2003–2007 | Patients aged ≥17 years with MRSA VAP treated with ≥4 days of VAN therapy | Retrospective study (n = 72) | Initial single trough level measured after ≥3 doses of VAN therapy in patients with normal renal function or after a minimum of 5 estimated VAN half lives in patients with renal insufficiency or requiring hemodialysis | Mean durations of VAN were 10.8 days (range 7–23) and 11.6 days (range 7–42 days) for patients with trough levels <15 and ≥15 mg/L, respectively |
Choi et al. [13] | Korea | 2002–2010 | Patients aged ≥15 years with MRSAB who received VAN for >48 h, and who had at least one VAN trough level measurement within 3–7 days into VAN therapy | Retrospective cohort study (n = 73) | Not stated | NA |
Chung et al. [36] | Korea | 2005–2007 | Patients aged ≥18 years in the ICU who had MRSA pneumonia infection treated with VAN for ≥72 h | Prospective study (n = 68) | Initial trough level measured immediately before the next dose after 3–5 doses of VAN therapy | Mean durations of VAN were 15.5 and 12.8 days for patients with trough levels <15 and ≥15 mg/L, respectively |
Clemens et al. [37] | USA | 2008–2009 | Patients aged ≥18 years with MRSAB who received VAN ≥24 h, and who had a documented steady-state VAN trough concentration measurement | Retrospective cohort study (n = 94) | Initial single trough level measured immediately before a scheduled dose after ≥24 h of completing VAN therapy | Average duration of VAN was 14.8 days (range 4–56) |
Honda et al. [73] | USA | 2005–2007 | Patients aged ≥18 years with MRSAB who received VAN as initial therapy, and who had a documented steady-state VAN trough concentration measurement | Prospective cohort study (n=151) | Initial trough level measured before the 4th dose of VAN | NA |
Kullar et al. [33] | USA | 2005–2010 | Adult patients with MRSAB infection who received VAN as initial therapy for ≥72 h | Retrospective cohort study (n = 280) | Initial trough level measured immediately before the 4th dose of VAN | NA |
Hermsen et al. [35] | USA | 2005–2007 | Patients aged ≥19 years with MRSA pneumonia, endocarditis, or osteomyelitis treated with VAN for ≥5 days, and who had at least one VAN trough concentration measurement | Retrospective cohort study (n = 55) | Average | Median durations of VAN were 12 days (P25–P75: 8–18) and 11 days (P25–P75: 7–16) for patients with trough levels <15 and ≥15 mg/L, respectively |
Jeffres et al. [31] | USA | 1999–2005 | All hospitalized patients with MRSA HCAP treated with VAN for ≥72 h | Retrospective cohort study (n =  = 94) | Initial trough level measured immediately after the 3rd dose of VAN | NA |
Hidayat et al. [30] | California, USA | 2004–2005 | Patients aged ≥18 years infected with any type of nosocomial MRSA treated with VAN for ≥72 h | Prospective cohort study (n = 95) | Initial and average | Mean durations of VAN were 11.5 days (range 6.5–13.5) and 12 days (range 7–17) for patients with trough levels <15 and ≥15 mg/L, respectively |