LAUSR

AIMS The aim was to quantify the relationship between pharmacist intervention and vancomycin associated AKI. METHODS Electronic databases were searched up to August 2020 for meta-analyses of cohort studies and/or randomized controlled trials. Studies that compared the incidence of AKI in patients between post- and pre- pharmacist intervention were investigated. The primary outcome was incidence of AKI. We also evaluated the influence of pharmacist intervention in risk factors of vancomycin associated AKI. RESULTS The search strategy retrieved 1744 studies and 34 studies with 19298 participants were included (22 published articles and 12 abstracts from conference proceedings). Comparing with pre-intervention group, the post-intervention group patients had a significantly lower incidence of vancomycin associated AKI: 7.3% for post- and 9.6% for pre-intervention (OR 0.52, 95% CI. [0.41-0.67], P < 0.00001). The rate of attaining target concentration was significantly higher in the post- than pre-intervention group (OR 2.86, 95% CI. [2.23, 3.67], P < 0.00001). The post-intervention group significantly improved the percentage of serum creatinine laboratory tests than pre-intervention group (OR = 3.24, 95% CI. 2.02-5.19], P < 0.00001). Patients with post-intervention had markedly lower risk of mortality than pre-intervention patients (OR 0.47, 95% Cl. [0.31, 0.72], P = 0.0004). CONCLUSIONS Pharmacist intervention in vancomycin treatment significantly decreased the rate of vancomycin associated AKI, while improving efficacy and reducing mortality. We speculate it is due to that the pharmacist interventions optimized the rationality of vancomycin therapy, monitoring of vancomycin trough concentration and the monitoring of patients' renal function.