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Table 1 Summarized characteristics of the eligible studies in the meta-analysis

From: 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

Author Country Study period Patient characteristic Study design
(No. of subjects)
Timing of vancomycin trough level measurement Duration of vancomycin therapy
Casapao et al. [65, 66] 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
  1. MRSA IE MRSA infective endocarditis, VAN vancomycin, NA not available, MRSAB MRSA bacteremia, VAP ventilator associated pneumonia, ICU intensive care unit, P25 25th percentile, P75 75th percentile, HCAP health care-associated pneumonia