The Correlation Between Vancomycin Trough Concentration And Neonatal Clinical Outcomes: A Meta Analysis

Objective: To evaluate the correlation between the trough levels of vancomycin and its efficacy and safety in treatment of neonatal infections.Methods: Pubmed,Embase,Web of Science,Cochrane Library and three Chinese databases(Wanfang,CNKI,CBM)were searched comprehensively.The search period was from the construction of library to March 1,2020.Collect all the literatures on the correlation between vancomycin trough concentration and clinical outcomes in newborns,screen the literatures according to Cochrane systematic review method,score the quality of the literatures,and extract the characteristic information and relevant research data of the included studies.The results of binary variables are expressed as odds ratios(ORs)and 95% confidence intervals(95%CI).If there's no statistical heterogeneity,a fixed-effect model is used.Clinical outcome indicators include: clinical effectiveness,bacteriological clearance rate,hepatotoxicity,nephrotoxicity and ototoxicity incidence.Results: A total of 17 cohort studies were included.Compared to children with vancomycin trough concentration <10mg/L,trough concentration ?10mg/L is more clinically effective(OR=5.76,95%CI: 3.01~11.03,P<0.00001),has a higher bacterial clearance(OR=4.86,95%CI: 1.95~12.13,P=0.0007),but a higher nephrotoxicity incidence(OR=3.87,95%CI:1.71~8.75,P=0.001),and a higher ototoxicity incidence(OR=2.06,95%CI: 1.17~3.65,P=0.01),incidence of hepatotoxicity and was not significantly different;compared with 10~20mg/L,the group whose trough concentration >20mg/L has a significantly increased incidence of nephrotoxicity(OR=3.98,95%CI: 1.67~9.46,P=0.002),clinical effectiveness,bacteriological clearance rate and incidence of hepatotoxicity and ototoxicity were not significantly different;vancomycin trough concentration level has no significant correlation with the incidence of hepatotoxicity in newborns.Conclusion:Vancomycin trough level in neonates is correlated with its clinical efficacy and safety.When the trough concentration is 10~20mg/L,there is better efficacy compared to <10mg/L,and lower adverse reactions but equivalent efficacy compared to >20mg/L.Therefore,it is advisable to control the trough concentration of vancomycin in neonates at 10~20mg/L.Therapy drug monitoring should be routinely conducted when using vancomycin in newborns to ensure its efficacy and safety.