Publications bias was assessed by the Begg funnel plot and the Egger's test. If the P<0.1 or I 2 more than 50%, a sensitivity analysis was conducted to assess the validity of outcomes. To account for the low statistical power of the X 2 test for heterogeneity, P<0.1 was considered significant. Heterogeneity among studies was assessed using X 2 test for heterogeneity and quantified using the Higgins I 2. Subgroup analyses were conducted according to the study design (RCT or Cohort studies) and geographic location of patients (Asian population or non-Asian population). Otherwise random effects models were used. Pooled weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated for continuous outcomes (duration of vancomycin therapy and length of hospital stay) using inverse variance fixed effects models if no significant heterogeneity was present. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for categorical outcomes (clinical efficacy and nephrotoxicity) using the Mantel-Haenszel fixed-effects models because there was no evidence of significant heterogeneity for these outcomes. The objective of this systematic review and meta-analysis was to evaluate the available evidence regarding the benefits of vancomycin TDM in patients treated with vancomycin for Gram-positive infections.Īll statistical analyses were conducted in STATA 12.0. We hypothesize that vancomycin TDM would allow a greater proportion of patients to achieve therapeutic target concentrations of vancomycin in the serum and increase clinical efficacy. This could decrease the therapeutic antibacterial activity of vancomycin. Many studies have shown that high proportions of patients do not achieve therapeutic target concentrations of vancomycin –. However, the clinical outcomes associated with vancomycin TDM have not been systematically quantified.Īs clinical failure in patients with MRSA infections has been increasingly reported in recent years –, higher serum vancomycin concentrations are needed to guarantee clinical efficacy. The consensus review from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists, as well as the consensus review from the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring all recommended monitoring serum concentrations of vancomycin to minimize nephrotoxicity and maximize efficacy. This controversy has led many hospitals to not monitor vancomycin serum concentrations, especially in developing countries. However, the practice of routine monitoring serum vancomycin concentrations has been the subject of intense debate for many years –. Due to the fact that the early use of vancomycin was associated with a number of adverse effects, including nephrotoxicity, infusion-related toxicities and possible ototoxicity, therapeutic drug monitoring (TDM) of vancomycin was advocated. She is a Massachusetts native who enjoys dancing, weightlifting, and traveling and frequently works on the work/life balancing act.Vancomycin has been long considered the gold standard therapy for methicillin-resistant Staphylococcus aureus (MRSA). Sanchez is focused on her health and wellness, she enjoys hiking with her puppy, Nala. Sanchez brings knowledge and expertise in many orthopedic conditions, including incontinence, constipation, pelvic pain, pain with intercourse, prolapse, and caring for pregnant and postpartum women. In 2017, she completed the Kaiser Permanente Residency Program and received an Orthopedic Specialist Certification in 2018.ĭr. Sanchez received her BS in Exercise Science in 2013 and a Doctorate in Physical Therapy in 2016 from D'Youville University in Buffalo, New York. She specializes in orthopedic and pelvic floor conditions in men, women, and gender-diverse populations. Sanchez is a physical therapist at ZK Outpatient Rehabilitation Center (ZKORC). Doctor of Physical Therapy | Pelvic Floor Physical Therapistĭr.
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