***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Different dosing regimens for vancomycin are in clinical use : intermittent infusion and continuous administration . The intention of using these different dosing regimens is to reduce toxicity , to achieve target levels faster and to avoid treatment failure . The aim of this phase IV study was to compare safety and effectiveness in both administration regimens . The study was conducted in 2010 and 2011 in three postoperative intensive care units ( ICUs ) in a tertiary care university hospital in Berlin , Germany . Adult patients with vancomycin therapy and therapeutic drug monitoring were included . Out of 675 patients screened , 125 received vancomycin therapy , 39 % with intermittent and 61 % with continuous administration . Patients with continuous administration achieved target serum levels significantly earlier ( median day 3 versus 4 , p=0.022 ) and showed fewer sub-therapeutic serum levels ( 41 % versus 11 % , p<0.001 ) . ICU mortality rate , duration of ICU stay and duration of ventilation did not differ between groups . Acute renal failure during the ICU stay occurred in 35 % of patients with intermittent infusion versus 26 % of patients with continuous application ( p=0.324 ) . In conclusion , continuous administration of vancomycin allowed more rapid achievement of targeted drug levels with fewer sub-therapeutic vancomycin levels observed . This might indicate that patients with more severe infections or higher variability in renal function could benefit from this form of administration Background Lack of appropriate reporting of method ological details has previously been shown to distort risk of bias assessment s in r and omized controlled trials . The same might be true for observational studies . The goal of this study was to compare the Newcastle-Ottawa Scale ( NOS ) assessment for risk of bias between review ers and authors of cohort studies included in a published systematic review on risk factors for severe outcomes in patients infected with influenza . Methods Cohort studies included in the systematic review and published between 2008–2011 were included . The corresponding or first authors completed a survey covering all NOS items . Results were compared with the NOS assessment applied by review ers of the systematic review . Inter-rater reliability was calculated using kappa ( K ) statistics . Results Authors of 65/182 ( 36 % ) studies completed the survey . The overall NOS score was significantly higher ( p < 0.001 ) in the review ers ’ assessment ( median = 6 ; interquartile range [ IQR ] 6–6 ) compared with those by authors ( median = 5 , IQR 4–6 ) . Inter-rater reliability by item ranged from slight ( K = 0.15 , 95 % confidence interval [ CI ] = −0.19 , 0.48 ) to poor ( K = −0.06 , 95 % CI = −0.22 , 0.10 ) . Reliability for the overall score was poor ( K = −0.004 , 95 % CI = −0.11 , 0.11 ) . Conclusions Differences in assessment and low agreement between review ers and authors suggest the need to contact authors for information not published in studies when applying the NOS in systematic review ABSTRACT A continuous infusion of vancomycin ( CIV ) may provide an alternative mode of infusion in severe hospital-acquired methicillin-resistant staphylococcal ( MRS ) infections . A multicenter , prospect i ve , r and omized study was design ed to compare CIV ( targeted plateau drug serum concentrations of 20 to 25 mg/liter ) and intermittent infusions of vancomycin ( IIV ; targeted trough drug serum concentrations of 10 to 15 mg/liter ) in 119 critically ill patients with MRS infections ( bacteremic infections , 35 % ; pneumonia , 45 % ) .  Microbiological and clinical outcomes , safety , pharmacokinetics , ease of treatment adjustment , and cost were compared . Microbiological and clinical outcomes and safety were similar . CIV patients reached the targeted concentrations faster ( 36 ± 31 versus 51 ± 39 h , P = 0.029 ) and fewer sample s were required for treatment monitoring than with IIV patients ( 7.7 ± 2.2 versus 11.8 ± 3.9 per treatment , P < 0.0001 ) . The variability between patients in both the area under the serum concentration-time curve ( AUC24h ) and the daily dose given over 10 days of treatment was lower with CIV than with IIV ( variances , 14,621 versus 53,975 mg2/liter2/h2[P = 0.026 ] and 414 versus 818 g2[P = 0.057 ] , respectively ) . The 10-day treatment cost per patient was $ 454 ± 137 in the IIV group and was 23 % lower in the CIV group ( $ 321 ± 81 : P < 0.0001 ) . In summary , for comparable efficacy and tolerance , CIV may be a cost-effective alternative to IIV PURPOSE Target plasma level achievement has remained a challenge in neurosurgical intensive care unit patients receiving intravenous vancomycin .  We evaluated continuous infusion ( CI ) and intermittent vancomycin dosing strategies in these patients . METHODS This retrospective cohort compared CI vancomycin ( target r and om levels , 20 - 30 mg/L ) to intermittent vancomycin ( target troughs , 15 - 20 mg/L ) in regards to achievement of target plasma levels , nephrotoxicity , pharmacodynamic target attainment , and cost savings in 130 patients . RESULTS Continuous infusion result ed in greater achievement of goal plasma concentrations at the first steady-state level ( 40 vs 21.5 % , P = .02 ) , more rapid achievement of goal plasma concentrations ( 2.04 vs 3.76 days , P < .0001 ) , and increased time within therapeutic range ( 55 % vs 34 % , P < .0001 ) but no significant difference in nephrotoxicity ( 15.4 % vs 21.5 % , P = .5 ) . Continuous infusion improved pharmacodynamic target attainment ( 92.3 % vs 30.8 % , P < .0001 ) and also reduced levels drawn ( 3.8 vs 5.7 , P = .0007 ) , dose adjustments ( 1.4 vs 2.4 , P = .0006 ) , days of therapy ( 10.4 vs 14.1 , P = .01 ) , and mean total daily dose requirements ( 33 vs 35.7 mg/kg , P < .0001 ) per patient . CONCLUSIONS Continuous infusion appears beneficial for improving attainment of target plasma concentrations , pharmacodynamic goals , and financial burden , without increasing risk of acute kidney injury Current guidelines for the empiric treatment of ventilator-associated pneumonia ( VAP ) recommend that vancomycin is dosed 15 mg/kg and administered twice daily for a target trough level of 15 to 20 mg/mL. This study compared conventional intermittent vancomycin infusion ( IVI ) with continuous vancomycin infusion ( CVI ) . Our prospect i ve , r and omized study compared CVI with IVI in trauma patients with suspected VAP . The primary outcome measure was a serum vancomycin level within the target level 48 hours after initiation of therapy . Treatment groups were compared using st and ard statistical methods . The study included 73 patients , 36 IVI and 37 CVI . Eighteen patients were withdrawn from the study as a result of discontinuation of the drug before 48 hours or failure to draw levels at the appropriate time , result ing in 27 IVI and 28 CVI study patients . There were no differences between treatment groups in gender ( P = 0.97 ) , Injury Severity Score ( P = 0.70 ) , total body weight ( P = 0.36 ) , or age ( P = 0.81 ) . The mean serum vancomycin level for the IVI group was 8.9 ± 3.9 mg/mL , and the CVI level was 19.8 ± 6.13 mg/mL ( P < 0.0001 ) . Two patients in the IVI group ( 7.4 % ) were in the therapeutic range compared with 16 ( 57.1 % ) in the CVI group ( P < 0.0001 ) . Six patients in the CVI group ( 21.4 % ) and none of the IVI patients had supratherapeutic levels . Four patients developed renal insufficiency , three IVI ( 11.1 % ) and one CVI ( 3.6 % ) ( P = 0.36 ) . The current American Trauma Society dosing recommendations for vancomycin for presumptive VAP treatment are inadequate . Continuous vancomycin infusion should be adopted as the st and ard dosing strategy 
    Output:
    
Conclusions : When administered via a continuous infusion , vancomycin is associated with a 53 % reduction in the odds of acute kidney injury and a 2.6-fold higher odds of pharmacokinetic target attainment when compared with intermittent infusion without influencing overall mortality