Meta-analysis shows pharmacist interventions improve vancomycin TDM outcomes and reduce kidney injury risk

ObjectiveTo systematically evaluate the impact of pharmacist interventions on the implementation and clinical efficacy of vancomycin therapeutic drug monitoring (TDM).MethodsA Cochrane systematic review methodology was employed. Databases including PubMed, Medline, Embase, Cochrane Library, CNKI, and Sinomed were searched. After quality assessment and data extraction of eligible clinical studies, Meta-analysis was performed using Stata 18.0 to compare the differences between the pharmacist intervention group and the non-pharmacist intervention group in terms of the incidence of acute kidney injury, clinical effective rate, 30-day mortality, correct blood sampling time rate, target blood concentration attainment rate, TDM sampling rate, etc.ResultsA total of 63 studies were included in the Meta-analysis. The results showed that pharmacist interventions reduced the incidence of acute kidney injury (RR = 0.67, 95% CI = 0.57, 0.78, P < 0.05), improved the clinical effective rate (RR = 1.11, 95% CI = 1.06, 1.17, P < 0.05), reduced 30-day mortality (RR = 0.52, 95% CI = 0.33, 0.82, P < 0.05), increased the correct TDM blood sampling time rate (RR = 1.52, 95% CI = 1.25, 1.83, P < 0.05), increased the target blood concentration attainment rate (RR = 1.60, 95% CI = 1.49, 1.72, P < 0.05), increased the TDM sampling rate (RR = 1.65, 95% CI = 1.34, 2.04, P < 0.05), increased the proportion of dosage regimen adjustments based on TDM results (RR = 2.68, 95% CI = 1.93, 3.70, P < 0.05). There was no significant effect on the duration of medication, length of hospital stay or TDM timeliness. Subgroup analysis showed that In the 10–20 mg/L group and the group with no specified target range, the serum concentration attainment rate was improved under pharmacist intervention (RR = 1.61, 95% CI = 1.50, 1.73, P < 0.05; RR = 1.49, 95% CI = 1.07, 2.08, P < 0.05). In the groups defined by serum creatinine increase ≥0.5 mg/dL or ≥50% from baseline, and serum creatinine increase ≥0.3 mg/dL or ≥50% from baseline, pharmacist interventions reduced the incidence of acute kidney injury (RR = 0.58, 95% CI = 0.45, 0.74, P < 0.05; RR = 0.64, 95% CI = 0.48, 0.85, P < 0.05).ConclusionThis study indicates that in patients treated with vancomycin under TDM, pharmacist interventions can promote the standardization of vancomycin TDM, reduce the incidence of acute kidney injury, and improve clinical outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261301721, identifier CRD420261301721.