Background: Vancomycin is a first-line antibiotic for methicillin-resistant Staphylococcus aureus infections or other Gram-positive infections. The area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio is proposed as a therapeutic drug-monitoring parameter. How well clinical efficacy is predicted by this measure has not been established. Objective: Determine the test performance characteristics (TPC) of AUC:MIC of vancomycin for prediction of positive outcome. Data Sources: PubMed and Ovid Medline (1946Medline ( to 2018 and EMBASE (1974EMBASE ( to 2018. Study Eligibility Criteria and Participants: Studies of patients treated with vancomycin for any type of infection in peer reviewed publications. All patient populations were included. Interventions: Vancomycin AUC:MIC or AUC was related to patient clinical outcome. Methods: Searches of medical databases using relevant terms were performed. Screening, study reviewing, data extracting and assessing data quality was performed independently by two reviewers. Studies were stratified by type of primary outcome for calculation of pooled sensitivity, specificity and construction of hierarchical summary receiver operating characteristic (HSROC) curves. Results: Nineteen studies including 1699 patients were meta-analysed. Pooled sensitivity and specificity were 0.77 (95% CI 0.67e0.84) and 0.62 (95% CI 0.53e0.71) respectively for the seven studies with primary outcome of mortality and 0.65 (95% CI 0.53e0.75), 0.58 (95% CI 0.48e0.67) for studies with composite or clinical cure outcome (n ¼ 12). HSROC curves suggested considerable heterogeneity. An additional 11 studies were described but could not be included for meta-analysis because data were not available. The majority of these studies (9/11) failed to demonstrate a relationship between AUC:MIC and positive clinical outcome. Conclusions: Vancomycin AUC:MIC performance was modest and inconsistent. Analysis was limited by studies without sufficient data; therefore, meta-analytic results may overestimate TPC values. Given this, as well as the lack of standardization of methods, widespread adoption of AUC:MIC as the preferred vancomycin monitoring parameter may be premature.
Background: Thiamine (vitamin B 1 ) is an essential cofactor responsible for the breakdown of glucose, and its deficiency is associated with Wernicke encephalopathy (WE). There is a lack of evidence from systematic studies on the optimal dosing of thiamine for WE.
<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Gastroesophageal varices are the most common cause of upper gastrointestinal bleeding (UGIB) in patients with cirrhosis. Vitamin K1 is commonly administered to patients presenting with UGIB and</p><p>elevated international normalized ratio, despite limited evidence to support this practice.</p><p><strong>Objectives: </strong>The primary objective was to describe the incidence of rebleeding within 30 days after vitamin K1 administration in patients with cirrhosis and UGIB. The secondary objective was to describe prescribing patterns for vitamin K1.</p><p><strong>Methods: </strong>This retrospective, descriptive multicentre study involved patients with cirrhosis and UGIB who were admitted to any of the 4 adult acute care hospitals in Calgary, Alberta, from January 1, 2014, to December 31, 2016. Patients were divided into 2 groups: those who received vitamin K1 and those who did not.</p><p><strong>Results: </strong>A total of 370 patients met the inclusion criteria, of whom 243 received vitamin K1 and 127 did not. Baseline characteristics were similar between the groups. Greater proportions of patients in the vitamin K1 group received transfusions of packed red blood cells, fresh frozen plasma, platelets, cryoprecipitate, or prothrombin concentrate during their admissions. There was no significant difference in the duration of octreotide and pantoprazole infusions. Among patients in the vitamin K1 group, there were more admissions to the intensive care unit and longer</p><p>lengths of stay. More patients in the no vitamin K1 group had esophageal varices evident on endoscopy that required endoscopic treatment. Forty of the patients (16.5%) in the vitamin K1 group and 7 (5.5%) in the no</p><p>vitamin K1 group had rebleeding within 30 days of the initial bleed. The median total vitamin K1 dose administered was 25 mg.</p><p><strong>Conclusions: </strong>The study results suggest that vitamin K1 does not reduce the incidence of rebleeding within 30 days of the initial bleed in patients with cirrhosis and UGIB.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>Les varices oesophagiennes sont la cause la plus fréquente de l’hémorragie gastro-intestinale supérieure (HGIS) parmi les patients atteints de cirrhose. On administre communément de la vitamine K1 aux patients</p><p>présentant une HGIS et dont la mesure du rapport international normalize (RIN) est élevée, malgré le manque de preuves soutenant cette pratique.</p><p><strong>Objectifs : </strong>L’objectif principal consistait à décrire la fréquence de la reprise du saignement dans les 30 jours après l’administration de la vitamine K1 à des patients atteints de cirrhose et de HGIS. L’objectif secondaire consistait à décrire les schémas de prescription de la vitamine K1.</p><p><strong>Méthode : </strong>Cette étude multicentrique, descriptive et rétrospective comprenait des patients atteints de cirrhose et de HGIS, ayant été admis à n’importe lesquels des quatre hôpitaux de soins actifs pour adultes de Calgary, Alberta, du 1er janvier 2014 au 31 décembre 2016. Les patients étaient répartis en deux groupes : ceux ayant reçu de la vitamin K1 et ceux n’en ayant pas reçu.</p><p><strong>Résultats : </strong>Le nombre total de 370 patients correspondait aux critères d’inclusion. Parmi ceux-ci, 243 avaient reçu de la vitamine K1 et 127 n’en n’avaient pas reçu. Les caractéristiques de base étaient similaires entre les</p><p>groupes. Un plus grand nombre de patients du groupe « Vitamine K1 » avaient reçu une transfusion d’un concentré de globules rouges, de plasma frais congelé, de plaquettes, de cryoprécipité ou de concentré de prothrombine au cours de leur séjour hospitalier. On n’a noté aucune différence significative dans la durée des injections de pantoprazole et d’octréotide. Le nombre d’admissions de patients du groupe « Vitamine K1 » à l’unité de soins intensifs était plus élevé et le séjour de ceux-ci était plus long. L’endoscopie a montré qu’un plus grand nombre de patients du groupe « Sans vitamine K1 » présentaient des varices oesophagiennes nécessitant un traitement endoscopique. Dans les 30 jours après le saignement initial, quarante (16,5 %) patients du groupe « Vitamine K1 » et 7 (5,5 %) du groupe « Sans vitamine K1 » ont subi une nouvelle hémorragie. La dose moyenne totale de vitamine K1 administrée était de 25 mg.</p><p><strong>Conclusions : </strong>Les résultats de l’étude tendent à démontrer que la vitamin K1 ne réduit pas la fréquence de la reprise du saignement dans les 30 jours qui suivent le saignement initial parmi les patients atteints de cirrhose et de HGIS.</p>
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