目的 分析不同谷浓度的万古霉素对新生儿感染的临床疗效及安全性,确定万古霉素的最佳谷浓度范围.方法 检索 PubMed、Web of Science A Embase 等数据库,主题词为"vancomycin""infant,newborn""drug monitoring""trough concentration",检索时间为建库至2023年5月,万古霉素谷浓度分组为＜10 μg·mL-1、[10,20)μg·mL-1和≥20μg·mL-1.使用RevMan 5.3软件进行Meta分析.结果 纳入16项研究,包括1581例新生儿.与万古霉素谷浓度＜10μg·mL-1组相比,[10,20)μg·mL-1 组的临床有效率[OR=4.78,95％CI(2.58,8.85),P＜0.01]和微生物清除率更高[OR=10.14,95％CI(4.84,21.24),P＜0.01],肾毒性、肝毒性和耳毒性发生率的差异无统计学意义;与万古霉素谷浓度≥ 20 μg·mL-1组相比,[10,20)μg·mL-1组的肾毒性发生率更低[OR=0.21,95％CI(0.10,0.45),P＜0.01],疗效、微生物清除率、肝毒性和耳毒性发生率比较差异无统计学意义(P＞0.05).结论 万古霉素谷浓度[10,20)μg·mL-1可提高新生儿感染的临床疗效,≥20 μg·mL-1应警惕肾毒性风险.
Meta-analysis of clinical efficacy and safety of vancomycin trough concentration range on neonates with infectious diseases
AIM To evaluate the impact of different vancomycin trough serum concentrations on clinical efficacy and safety in neonates and determine its optimal range.METHODS PubMed,Web of Science,Embase and other databases were searched with keywords of"Vancomycin","Infant,newborn","Drug monitoring"and"Trough concentration"from inception to May 2023.The target trough concentrations were grouped as[10,20)μg·mL-1,＜10μg·mL-1 and ≥ 20 μg·mL-1.RevMan5.3 software was used for the Meta-analysis.RESULTS A total of 16 studies involving 1 581 neonates were included.Compared with neonates with vancomycin trough concentrations＜10 μg·mL-1,those with trough concentrations ranging from 10 to less than 20 μg·mL-1 had higher clinical efficacy rates[OR=4.78,95％CI(2.58,8.85),P＜0.01]and higher microbial clearances[OR=10.14,95％CI(4.84,21.24),P＜0.01],while there was no difference in incidence of nephrotoxicity,hepatotoxicity and ototoxicity.Compared with neonates with vancomycin trough concentrations ≥ 20 μg·mL-1,trough concentrations ranging from 10 to less than 20 μg·mL-1 had lower incidence of nephrotoxicity[OR=0.21,95％CI(0.10,0.45),P＜0.01],while there was no difference in clinical efficacy rate,microbial clearance,incidence of hepatotoxicity and ototoxicity(P＞0.05).CONCLUSION A vancomycin trough concentration ranging from 10 to less than 20 μg mL-1 can improve clinical efficacy in neonates,while trough concentrations ≥ 20 μg·mL-1 may increase the incidence of nephrotoxicity.
vancomycintrough concentrationtherapeutic drug monitoringadverse drug reactionMeta-analysis
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