{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T11:38:57Z","timestamp":1794310737065,"version":"4.9.0"},"reference-count":40,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      Vancomycin is commonly used to treat methicillin\u2010resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      infections and is known to cause nephrotoxicity. Previous Vancomycin Consensus Guidelines recommended targeting trough concentrations but the 2020 Guidelines suggest monitoring vancomycin area under the curve (AUC) given the reduced risk of acute kidney injury (AKI) at similar levels of efficacy. This meta\u2010analysis compares vancomycin\u2010induced AKI incidence using AUC\u2010guided dosing strategies versus trough\u2010based monitoring. Literature was queried from Medline (Ovid), Web of Science, and Google Scholar from database inception through November 5, 2021. Interventional or observational studies reporting the incidence of vancomycin\u2010induced AKI between AUC\u2010 and trough\u2010guided dosing strategies were included. In the primary analysis, the Vancomycin Consensus Guidelines definition for AKI was used if reported; otherwise, the Risk, Injury, and Failure; and Loss, and End\u2010stage kidney disease (RIFLE) or Kidney Disease Improving Global Outcomes (KDIGO) definitions were used. The incidence of nephrotoxicity was evaluated between the two strategies using a Mantel\u2013Haenszel random\u2010effects model, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Subgroup analyses for adjusted ORs and AKI definitions were performed. Heterogeneity was identified using Cochrane's\n                      <jats:italic>Q<\/jats:italic>\n                      test and\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistics. A total of 10 studies with 4231 patients were included. AUC\u2010guided dosing strategies were associated with significantly less vancomycin\u2010induced AKI than trough\u2010guided strategies [OR 0.625, 95% CI (0.469\u20130.834),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u200925.476]. A subgroup analysis of three studies reporting adjusted ORs yielded similar results [OR 0.475, 95% CI (0.261\u20130.863),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.015]. Stratification by AKI definition showed a significant reduction in AKI with the Vancomycin Consensus Guidelines definition [OR 0.552, 95% CI (0.341\u20130.894),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.016] but failed to find significance in the alternative definitions. Area under the curve\u2010guided dosing strategies are associated with a lower incidence of vancomycin\u2010induced AKI versus trough\u2010guided dosing strategies (GRADE, low). Limitations included the variety of AKI definitions and the potential for confounding bias.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.2722","type":"journal-article","created":{"date-parts":[[2022,7,23]],"date-time":"2022-07-23T02:49:45Z","timestamp":1658544585000},"page":"741-753","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":60,"title":["Vancomycin area under the curve versus trough only guided dosing and the risk of acute kidney injury: Systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1710-5952","authenticated-orcid":false,"given":"Emily","family":"Abdelmessih","sequence":"first","affiliation":[{"name":"Ernest Mario School of Pharmacy, Rutgers The State University of New Jersey  Piscataway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandini","family":"Patel","sequence":"additional","affiliation":[{"name":"Ernest Mario School of Pharmacy, Rutgers The State University of New Jersey  Piscataway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janaki","family":"Vekaria","sequence":"additional","affiliation":[{"name":"Ernest Mario School of Pharmacy, Rutgers The State University of New Jersey  Piscataway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brynna","family":"Crovetto","sequence":"additional","affiliation":[{"name":"Touro College of Pharmacy  New York New York USA"},{"name":"Department of Pharmacy Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savanna","family":"SanFilippo","sequence":"additional","affiliation":[{"name":"Tabula Rasa Healthcare  Moorestown New Jersey USA"},{"name":"Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers The State University of New Jersey  Piscataway New Jersey USA"},{"name":"Robert Wood Johnson University Hospital Somerset  Somerville New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers The State University of New Jersey  Piscataway New Jersey USA"},{"name":"Robert Wood Johnson University Hospital Somerset  Somerville New Jersey USA"},{"name":"La Jolla Pharmaceutical Company  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0565-6167","authenticated-orcid":false,"given":"Luigi","family":"Brunetti","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers The State University of New Jersey  Piscataway New Jersey USA"},{"name":"Robert Wood Johnson University Hospital Somerset  Somerville New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,8,5]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"StatPearls","author":"Patel S","year":"2022"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.12923"},{"key":"e_1_2_7_4_1","unstructured":"Association AH.Fast facts on U.S. hospitals;2022. 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