Is It Still Beneficial to Monitor the Trough Concentration of Vancomycin? A Quantitative Meta-Analysis of Nephrotoxicity and Efficacy.

This study conducted a quantitative meta-analysis to investigate the association of vancomycin indicators, particularly area under the curve over 24 h (AUC 24 ) and trough concentrations (C trough ), and their relationship with both nephrotoxicity and efficacy. Literature research was performed in PubMed and Web of Science on vancomycin nephrotoxicity and efficacy in adult inpatients. Vancomycin C trough , AUC 24 , AUC 24 /minimum inhibitory concentration (MIC), nephrotoxicity evaluation and treatment outcomes were extracted. Logistic regression and E max models were conducted, stratified by evaluation criterion for nephrotoxicity and primary outcomes for efficacy. Among 100 publications on nephrotoxicity, 29 focused on AUC 24 and 97 on C trough , while of 74 publications on efficacy, 27 reported AUC 24 /MIC and 68 reported C trough . The logistic regression analysis indicated a significant association between nephrotoxicity and vancomycin C trough (odds ratio = 2.193; 95% CI 1.582-3.442, p < 0.001). The receiver operating characteristic curve had an area of 0.90, with a cut-off point of 14.55 mg/L. Additionally, 92.3% of the groups with a mean AUC 24 within 400-600 mg·h/L showed a mean C trough of 10-20 mg/L. However, a subtle, non-statistically significant association was observed between the AUC 24 and nephrotoxicity, as well as between AUC 24 /MIC and C trough concerning treatment outcomes. Our findings suggest that monitoring vancomycin C trough remains a beneficial and valuable approach to proactively identifying patients at risk of nephrotoxicity, particularly when C trough exceeds 15 mg/L. C trough can serve as a surrogate for AUC 24 to some extent. However, no definitive cut-off values were identified for AUC 24 concerning nephrotoxicity or for C trough and AUC 24 /MIC regarding efficacy.