使用meta分析系统评价万古霉素血清谷浓度与儿童临床结局之间的关系。几个数据库,包括PubMed,Elsevier,WebofScience,EMBASE,Medline,clinicaltrials.gov,Cochrane图书馆,和三个中国数据库(万方数据,中国国家知识基础设施,和SINOMED),进行了全面搜索,以获得从开始到2021年12月在儿童中使用万古霉素的研究文章。所有研究均采用Cochrane系统评价方法进行筛选和评价。然后,提取特征信息进行荟萃分析.评估结果包括临床疗效,万古霉素相关肾毒性,肝毒性,耳毒性,死亡率,和微生物清除。共纳入35项研究,涉及4820名儿童。Meta分析显示,与万古霉素谷浓度<10μg/mL的患儿相比,万古霉素谷浓度≥10μg/mL的患者具有较高的临床有效率[OR:2.23,95%CI:1.29至3.84,P=0.004]和更高的肾毒性发生率[OR:2.76,95%CI:1.51至5.07,P=0.001],耳毒性[OR:1.87,95%CI:1.08~3.23,P=0.02]和微生物清除率[OR:2.36,95%CI:1.53~3.64,P=0.0001]。两组的全因死亡率[OR:1.07,95%CI:0.45至2.53,P=0.88]和肝毒性[OR:0.84,95%CI:0.46至1.53,P=0.57]相似。亚组分析表明,与万古霉素谷浓度为10至15μg/mL的儿童相比,万古霉素谷浓度>15μg/mL的患者肾毒性发生率较高[OR:2.64,95%CI:1.28~5.43,P=0.008],但临床疗效差异无统计学意义[OR:0.85,95%CI:0.30~2.44,P=0.76]。万古霉素谷浓度10~15μg/mL可提高患儿临床疗效。此外,避免谷浓度>15μg/mL可以降低不良反应的发生率。
To systematically evaluate the relationships between vancomycin trough serum concentrations and clinical outcomes in children using meta-analysis. Several databases, including PubMed, Elsevier, Web of Science, EMBASE, Medline, clinicaltrials.gov, the Cochrane Library, and three Chinese databases (Wanfang Data, China National Knowledge Infrastructure, and SINOMED), were comprehensively searched to obtain research articles on vancomycin use in children from inception through December 2021. All studies were screened and evaluated using the Cochrane systematic
review method. Then, the feature information was extracted for meta-analysis. The evaluated results included clinical efficacy, vancomycin-associated nephrotoxicity, hepatotoxicity, ototoxicity, mortality, and microbial clearance. A total of 35 studies involving 4820 children were included in the analysis. The meta-analysis showed that compared with children with vancomycin trough concentrations <10 μg/mL, those with vancomycin trough concentrations ≥10 μg/mL had a higher clinical efficacy rate [OR: 2.23, 95% CI: 1.29 to 3.84, P = 0.004] and higher incidences of nephrotoxicity [OR: 2.76, 95% CI: 1.51 to 5.07, P = 0.001], ototoxicity [OR: 1.87, 95% CI: 1.08 to 3.23, P = 0.02] and microbial clearance [OR: 2.36, 95% CI: 1.53 to 3.64, P = 0.0001]. All-cause mortality [OR: 1.07, 95% CI: 0.45 to 2.53, P = 0.88] and hepatotoxicity [OR: 0.84, 95% CI: 0.46 to 1.53, P = 0.57] were similar between the two groups. Subgroup analysis showed that compared with children with vancomycin trough concentrations of 10 to 15 μg/mL, those with vancomycin trough concentrations >15 μg/mL had a higher incidence of nephrotoxicity [OR: 2.64, 95% CI: 1.28 to 5.43, P = 0.008], but there was no significant difference in clinical efficacy [OR: 0.85, 95% CI: 0.30 to 2.44, P = 0.76]. A vancomycin trough concentration of 10 to 15 μg/mL can improve clinical efficacy in children. Additionally, avoidance of trough concentrations >15 μg/mL can reduce the incidence of adverse reactions.