{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T23:20:19Z","timestamp":1786404019581,"version":"build-2736575974"},"reference-count":41,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2015,10,24]],"date-time":"2015-10-24T00:00:00Z","timestamp":1445644800000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec><jats:title>Study Objective<\/jats:title><jats:p>To determine the strength of evidence for better clinical outcomes in patients with <jats:italic>Staphylococcus aureus<\/jats:italic> bacteremia who had vancomycin trough levels of 15\u201320\u00a0mg\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Meta\u2010analysis of 14 observational cohort studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>A total of 1677 patients, representing geriatric and unspecified inpatients, who received standard dosing of vancomycin for the treatment of <jats:italic>S.\u00a0aureus<\/jats:italic> bacteremia and who had trough level goals of 15\u201320\u00a0mg\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>The treatment variables examined in the analysis were vancomycin trough concentrations and 24\u2010hour area under the concentration\u2010time curve to minimum inhibitory concentration ratio (<jats:styled-content style=\"fixed-case\">AUC:MIC<\/jats:styled-content>) values. The outcomes of interest were mortality, persistent bacteremia, and treatment failure. Mortality was defined as 30\u2010day mortality, in\u2010hospital mortality, or a comparable measure; persistent bacteremia was defined as bacteremia lasting at least 7\u00a0days after the initiation of vancomycin; treatment failure was defined as a composite end point that included at least persistent bacteremia and mortality, as previously defined. Higher vancomycin trough levels (15\u00a0mg\/L or greater or based on <jats:styled-content style=\"fixed-case\">MIC<\/jats:styled-content>) were not associated with significantly reduced treatment failure, persistent bacteremia, or mortality. Higher <jats:styled-content style=\"fixed-case\">AUC:MIC<\/jats:styled-content> values were associated with significantly reduced treatment failure (odds ratio [OR] 0.41, 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 0.31\u20130.53), persistent bacteremia (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.53, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.33\u20130.86), and mortality (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.47, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.33\u20130.65). The weighted mean\u00a0\u00b1\u00a0<jats:styled-content style=\"fixed-case\">SD AUC:MIC<\/jats:styled-content> threshold defined by regression analyses in the included studies was 418\u00a0\u00b1\u00a088\u00a0hours, which supports the current goal of 400\u00a0hours or more.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Vancomycin trough concentrations do not have sufficient evidence to support their use as the primary guide in vancomycin dosing. Dosing should instead focus on <jats:styled-content style=\"fixed-case\">AUC:MIC<\/jats:styled-content> values, which have strong evidence of benefit.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.1638","type":"journal-article","created":{"date-parts":[[2015,10,24]],"date-time":"2015-10-24T19:37:56Z","timestamp":1445715476000},"page":"889-898","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":84,"title":["Vancomycin Trough Concentration as a Predictor of Clinical Outcomes in Patients with <i>Staphylococcus aureus<\/i> Bacteremia: A Meta\u2010analysis of Observational Studies"],"prefix":"10.1002","volume":"35","author":[{"given":"John P","family":"Prybylski","sequence":"first","affiliation":[{"name":"College of Pharmacy University of Florida Gainesville 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