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Review Article | DOI: https://doi.org/10.31579/2690-4861/755
1Division of Nephrology, Hypertension and Renal Transplant, Department of Medicine, University of the West Indies (Mona), Kingston, Jamaica.
2Department of Internal Medicine, Bronxcare Hospital Center, New York, United States of America.
3University Hospital of the West Indies, Mona Kingston Jamaica.
*Corresponding Author: Kyaw Kyaw Hoe, Consultant/Lecturer in Nephrology, Department of Medicine, University of the West Indies, Jamaica.
Citation: Kyaw K. Hoe, Adedamola Soyibo, Tin L. Han, (2025), Incidence, Risk Factors and Epidemiological Errors of Vancomycin Associated Acute Kidney Injury: A Systematic Review, International Journal of Clinical Case Reports and Reviews, 24(5); DOI:10.31579/2690-4861/755
Copyright: © 2025, Kyaw Kyaw Hoe. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 14 March 2025 | Accepted: 31 March 2025 | Published: 04 April 2025
Keywords: VA-AKI; vancomycin associated AKI; vancomycin induced nephropathy; acute kidney injury; vancomycin toxicity
Changes in the incidence of Vancomycin Associated-Acute Kidney Injury (VA-AKI), risk factors and applicability of studies are questionable in recent times. This review aims to evaluate the incidence, risk factors and the epidemiological errors of findings on VA-AKI.
All studies related to vancomycin associated acute kidney injury in the past 20 years were identified from PubMed, MEDLINE, Google scholar and UWIlinC. During the past decade, the incidence of VA-AKI varied between 7.3% to 15.8%. The lowest incidence was found among the patients who received pharmacist intervention prior to the initiation of therapy, and the highest incidence was among elderly patients over 65-year-old. Notable risk factors were old age, high trough ≥15 μg/mL, AUC/MIC ratio > 650 mg × hour/L, concomitant use of aminoglycosides, broad-spectrum antibiotics, diuretics and vasopressor, using vancomycin without pharmacist intervention, hyperuricemia, respiratory failure, cardiac failure, chronic kidney disease, mechanical ventilation, obesity and black race. Common epidemiological errors in these studies were generalization and selection bias. The disparity of facilities among healthcare services is a concern.
Knowing modifiable risks, using vancomycin as monotherapy and advance consultation with pharmacists seem valuable preventive tools for VA-AKI regardless of resource settings.
A surge of reports on VA-AKI was noted after the infectious disease guidelines recommended to use sufficient initial and maintenance vancomycin doses to prevent treatment failure in in 2005 and in 2009 [1-4]. The nephrotoxicity related to a higher trough level from 1995 to 2012 was checked extensively and found out that the incidence of VA-AKI varied from 5-43% [1]. A longitudinal study from 2016 to 2019 stated that therapeutic drug monitoring was able to do on only 32.3% among the patients exposed to vancomycin [2]. The concerned on the recommended higher trough level in 2005 for the treatment of pneumonias associated with hospital, healthcare services and ventilators was expressed [3]. The most immediate response to the recommended higher trough level was produced based on the results between 2006 to 2008 which revealed an alarming outcome as 81.8% of patients with the trough level exceeded more than 35 mg/L developed VA-AKI [4]. Fortunately, a recent report in 2022, the incidence declined to 7.3% among patients who received pharmacist intervention prior to intravenous vancomycin therapy [5]. In the past decade, the incidence reached as high as 15.8% among the elderly hospitalized patients in 2016-2017 [6]. Despite being well-recognized as a nephrotoxin, the incidence of VA-AKI remained un-earthed in certain regions, probably due to lack of vancomycin level monitoring facilities. A complete picture can be seen when the incidence and risk factors are well-generalized. We aimed to identify the recent changes in incidence, reports on risk factors and to explore epidemiological errors related to the VA-AKI.
Renal affinity of vancomycin
The accumulation of vancomycin occurred two times higher in kidneys than in plasma and its toxicity was dose related. The vancomycin concentration in the kidney increased by 3.5-fold with high dose vancomycin (600 mg/Kg) [7]. Up to 90% of vancomycin unchanged form are filtered to the proximal convoluted tubules (PCT), resulting in accumulation in the PCT lining cells where it was metabolized [8]. Murphy E and Barreto E declared that vancomycin is a nephrotoxin and alternative therapy should be considered, for high-risk patients, if possible [9].
Pathophysiology of VA-AKI
The pathological manifestation of VA-AKI includes acute tubular necrosis (ATN), acute tubulointerstitial nephritis (ATIN) and intratubular crystal obstruction. A pooled renal biopsy reported that a combination of acute tubular necrosis (ATN) and acute tubulointerstitial nephritis (ATIN) were the most common findings. The ATIN was found to have a significantly higher risk of permanent renal dysfunction [HR: 5.08, 95% CI: 91.05–24.50)] [10]. The accumulation of vancomycin molecules in the PCT cells triggers inflammatory reactions, oxidative stress, and complement activation. Subsequent mitochondrial dysfunction, and apoptosis of the renal tubular epithelial cells led to acute tubular necrosis [11]. Htike, N. L et al stated that the pathophysiology of ATIN was thought to be mediated by a type IV delayed hypersensitivity reaction involving T-cells [12]. A smaller subset of patients developed VA-AKI due to intratubular crystal obstructions in the distal convoluted tubules, where casts are formed by uromodulin and vancomycin precipitates in a low urinary acidity (pH Less than 5.5) state [13].
Search strategy and selection criteria
PubMed, MEDLINE, Google Scholar and UWIlinC databases were selected as search databases. The initial search terms were “vancomycin”, “acute kidney injury” or “acute renal failure” or “aki” and “nephrot* and “vancomycin trough” or “vancomycin auc/*”. The search included both animal and human studies over the past 20 years. All the articles are centered on the incidence and/or risk factors of VA-AKI. The articles detailing acute kidney injury, drug pharmacodynamics, clinical outcomes, publications in English language, studies focused on adults and studies accessible in full-text form are included. The exclusion criteria are duplicate publications, AKI not related to vancomycin, studies lacking adequate data (abstracts with no full text available), publications older than 20 years, and non-intravenous use of vancomycin.
Records identified were 81 from PubMed, 57 from MEDLINE, 2610 from Google Scholar and 1401 from UWIlinC (total n= 4158). Records removed before the screening were those articles which did not include vancomycin (n= 4082) and duplicate articles (n= 44). Of the remaining 32 records, articles with no renal association (n=5), study with sample size Less than 400 (n=5), article based on vancomycin via intra-articular spacers use (n=1), articles on pediatric studies (n=6) and textbook article published beyond the past 20 years (n=1) were removed. The final selected studies in this review were 14 in which 7 articles focused on both incidence and risk and 7 articles mainly focused on risk of VA-AKI. The range of study designs were 7 systemic reviews with meta-analyses, 2 systematic reviews, 3 cross sectional studies, 1 cohort study, and 1 case-control study. Most studies used serum creatinine levels as the primary biomarker for diagnosing AKI according to AKIN, RIFLE or KDIGO criteria. (Figure 1)
Figure 1: PRISMA flow diagram showing search strategy for literature review of VA-AKI
A systematic review and meta-analysis by van Hal SJ et al., (2012) stated that the incidence of VA-AKI from 1995 to April 2012 was between 5 – 43% [1]. A longitudinal study by Kunming P et al., (2021), revealed that the incidence of VA-AKI was 14.3%. In addition, these patients had longer hospital stays (23 vs. 20 days, p Less than 0.001) and a higher 30-day mortality rate (8.8% vs. 1.5%, p Less than 0.001) [2]. Among ICU patients with pneumonia, VA-AKI was as high as 15.4% and the independent risk factors were initial vancomycin trough levels ≥15 mg/L (OR, 5.2, 95% CI, 1.9-13.9; P = 0.001), concomitant aminoglycoside use (OR, 2.67; 95% CI, 1.09-6.54; P = 0.03), and duration of vancomycin therapy (OR for each additional treatment day, 1.12; 95% CI, 1.02-1.23; P = 0.02) [3]. A study by Horey A et al., (2012) revealed that the prevalence of vancomycin associated nephrotoxicity was 12.6% with maximum trough concentrations (OR 1.14; 95% CI 1.09 to 1.20) and documented hypotension (OR 4.7; 95% CI 1.3 to 16.4) were with higher risk [4]. A systematic review and meta-analysis in 2022 revealed that the incidence of VA-AKI without pharmacist intervention was 9.6% and with pharmacist intervention was 7.3%. Hence, the incidence of VA-AKI was 2.3% less among the patients who received pharmacist intervention in advance (OR 0.52, 95% CI 0.41, 0.67, P Less than .001) [5]. In terms of age-related risk, a cross-sectional study by Pan K et al (2018) on elderly patients over 65-years-old revealed that the incidence of VA-AKI was 15.8% [6]. The studies which included incidence as well as risk ratios were summarized in the table (Table 1).
| Author, year, [Ref #] | Aim | Study population | Study Design | Country (number of study) | Outcome Variables | Main Findings | Epidemiological errors |
Van Hal et al 2012 [1]
| To determine the nephrotoxicity potential of maintaining higher vancomycin troughs | 15 studies with sample sizes ranging from 45 to 333 patients.
| Systematic review and meta-analysis | USA (13) Korea (1) Slovakia (1) | Vancomycin associated Acute Kidney Injury (VA-AKI) | From 1995 to 2012, the incidence of VA-AKI ranges from 5% to 43%. Concomitant nephrotoxins use (OR, 3.30; 95% CI, 1.30 to 8.39; P = 0.01) and ICU patients (OR, 2.57; 95% CI, 1.44 to 4.58; P Less than0.01) were at risk. | It has selection and publication bias, as studies included a few countries, and only significant results were more likely to be published. |
| Kunming P et al 2021 [2] | To show the characteristics of VA-AKI | 3719 hospitalized adult patients between January 1, 2016 and June 2019 | Retrospective cohort | China (1) | VA-AKI | The incidence of VA-AKI was 14.3% among hospitalized patients. Concomitant piperacillin-tazobactam, cephalosporin and carbapenems therapy is at higher risk of AKI (OR 3.12, 95% CI 1.50-6.49, p = 0.002), (OR 1.55, 95% CI 1.08-2.21, p = 0.017), (OR 1.46, 95% CI 1.11-1.91, p = 0.006), respectively) | Large sample size increases the statistical power and reliability of the findings. The study excluded 998 patients due to missing serum creatinine measurements, which caused selection bias. As a single country-based study, generalization is low. |
Cano, E et al 2012 [3] | To report the incidence of nephrotoxicity and associated risk factors in intensive care unit patients who received vancomycin | 449 intensive care unit patients who received vancomycin for the treatment of HAP, VAP, and HCAP. | Retrospective multi-centre cross-sectional study | USA (1) | VA-AKI | The incidence of VA-AKI among ICU patients was 15.4%. Initial vancomycin trough levels ≥15 mg/L (OR, 5.2 [95% CI, 1.9-13.9]; P = 0.001), concomitant aminoglycoside use (OR, 2.67 | The study acknowledges concomitant aminoglycoside use was the strongest risk factor for nephrotoxicity but does not sufficiently control for other potential nephrotoxic medications. The ICU setting of America |
| for pneumonia | [95% CI, 1.09-6.54]; P = 0.03), and duration of vancomycin therapy (OR for each additional treatment day, 1.12 [95% CI, 1.02-1.23]; P = 0.02) were independent risk factors for VA-AKI. | would be different from other countries which decreased the generalization and external validity. | |||||
Kunming P et al 2022 [5] | To quantify the relationship between pharmacist intervention and vancomycin-associated acute kidney injury (AKI). | 34 studies with 19,298 participants | A systematic review and meta-analysis
| USA (18) Japan (4) China (4) Australia (3) Spain (1) Netherland (1) Iran (1) South Africa (1) | VA-AKI | Compared with the preintervention group, the postintervention group patients had a significantly lower incidence of vancomycin-associated AKI: 7.3% for post- and 9.6% for preintervention (odds ratio [OR] 0.52, 95% confidence interval; 0.41, 0.67, P Less than .00001). | In this meta-analysis, 12 out of 34 included studies were conference abstracts, which may have limited methodological details, lacked peer review, or contained incomplete data, reducing the overall strength and generalizability of the evidence. |
Pan K et al 2018 [6] | To investigate the current situation concerning, and risk factors for, vancomycin induced acute kidney injury (VI‐AKI) in elderly Chinese patients | 647 elderly in-patients over 65 years old | Cross sectional study | China | VA-AKI | The incidence of VA-AKI was 15.8%. Multiple logistic regression analysis revealed that hyperuricaemia [odds ratio (OR) = 3.045; P = 0.000)], mechanical ventilation (OR = 1.906; P = 0.022) and concomitant vasopressor therapy (OR = 1.919; P = 0.027) were independent risk factors for VI‐AKI | The study is focused on elderly Chinese patients, meaning the findings may not be directly applicable to younger populations or non-Chinese ethnic groups and the generalization is poor.
|
Elyasi, S et al 2012 [17] | To find out the safety of high doses vancomycin | Sixty-five articles were retrieved | Systematic review | USA (33) France (6) Japan (4) England (3) | VA-AKI | The incidence of Vancomycin-induced renal toxicity was | The review systematically addresses key aspects of vancomycin-induced |
| on vancomycin and nephrotoxicity |
China (3) Italy (3) Taiwan (2) Belgium (2) Australia (2) Israel (2) Singapore (1) Czechoslovakia (1) Slovakia (1) Brazil (1) Canada (1) | reported in 10–20 % and 30–40 % of patients following conventional and high doses of vancomycin therapy, respectively. | nephrotoxicity, including incidence rates, mechanisms, predisposing factors, and vulnerable populations. However, confounding by co-medications of other nephrotoxin could lead to an overestimation of the true nephrotoxic potential of vancomycin. | ||||
Qin, X., at el 2020 [33] | To study the incidence of vancomycin-associated acute kidney injury (VA-AKI) in Hong Kong and identify risk factors for VA-AKI. | 12,758 records with vancomycin prescription and measurement of serum drug level from January 2012 to December 2016 in Hong Kong | Systematic review | China (1)
| VA-AKI | The incidence was respectively 10.6, 10.9, 11.3, 12.2, 11.2% from 2012 to 2016. Serum trough vancomycin level (OR of 15.1~20.0 level: 2.50 (95%CI [2.13, 2.93], OR of > 20.0 level: 3.89 (95%CI [3.34, 4.53], respectively), respiratory failure (OR 1.38; 95% CI 1.22, 1.58), chronic renal failure (OR 3.17; 95% CI 2.72, 3.70) and congestive heart failure (OR 1.56; 95% CI 1.37,1.79, concomitant diuretics (OR 1.71; 95% CI 1.51,1.94), PTZ (OR 1.39; 1.24, 1.57) and meropenem (OR 1.29; 95% CI 1.16,1.45), were all associated with increased risk of VA-AKI. | This large sample size enhances reliability and generalizability. As a retrospective study relying on medical records, the data may be prone to incomplete reporting or missing or inaccurately documented could introduce recall and reporting bias (Information biases).
|
Table 1: Eligible Journal Articles on incidence and risk factors of Vancomycin Associated Acute Kidney Injury in adults.
VA-AKI, Vancomycin Associated Acute Kidney Injury; USA, United States of America; ICU, Intensive care unit; HAP, Hospital Acquired Pneumonia; VAP, Ventilator Associated Pneumonia; HCAP, Healthcare Associted Pneumonia; PTZ, Piparacillin-Tazoactam.
VA-AKI risk factors
A pooled results of 7 RCTs and 7 cohort studies on 4033 patients by Ray AS et al., (2016) concluded that the risk of nephrotoxicity was 2.5-fold higher in patients who received intravenous vancomycin [14]. Kim J.Y et al. (included 53 studies in a meta-analysis (n = 50-3719), revealed a higher risk of Vancomycin Associated AKI (VA-AKI) among black and obese population. (OR 1.47, 95% CI: 1.16–1.87 and OR 1.46, 95% CI: 1.12–1.90, respectively) [15]. Pan K et al expressed independent associations between VA-AKI and hyperuricemia (OR 3.045; 95% CI 1.834, 5.057; P = Less than0.001), mechanical ventilation (OR 1.906; 95% CI 1.098; 3.310, P = 0.022) and concomitant vasopressor therapy (OR 1.919; 95% CI 1.078, 3.418; P = 0.027) [6]. A prospective cohort by Lodise, T (2008), found that the prevalence of AKI among patients who received vancomycin >4 G/day, Less than4/day and linezolid was noted as 34.6%, 10.9%, and 6.7%, respectively (P = 0.001) [16]. A systematic review by Elyasi et al., reported that high dose vancomycin >4 G/day, trough level >20 mg/dL and longer duration of therapy > 7 days were associated with higher prevalence of VA-AKI compared to the conventional dose (30-40% vs 10-20%) [17].
Among the critically ill patients, backwards logistic regression analysis by Hanrahan T.P (2015) revealed serum vancomycin concentration and APACHE II score as independent positive predictors (OR= 1.174, P= 0.024 and OR= 1.141, P= 0.012, respectively) [18]. A meta-analysis done in 2022 focused on the first 24 hours (0-24 hours) and second 24 hours (24-48 hours) vancomycin troughs. AKI was significantly less when trough level area under curve (AUC) was less than 650 mg×h/L [19]. Abdelmessih, E et al (2022) augmented another meta-analysis which showed that the VA-AKI was significantly lower in the AUC-guided dosing strategies than trough-guided dosing strategies (OR 0.625, 95% CI (0.469–0.834), p = 0.001) [20]. In 2021, Tsutsuura M et al found a significantly lower rate of treatment failure in patients with the trough level ≥ 15 µg/mL ((OR 0.63, 95% CI 0.47–0.85) but when trough concentrations ≥20 μg/mL, the rate of AKI was two times higher than trough concentrations between 15-20 μg/mL (OR 2.39, 95% CI 1.78–3.20) and target cut-off 600 ± 15% was associated with a higher risk of VA-AKI (OR 2.10, 95% CI 1.13–3.89) [21]. A retrospective cohort by Pitcock CT et al (2023) on prolonged vancomycin therapy (> 14 days) demonstrated a higher incidence of AKI (45.6% vs 28.4%, p Less than 0.001) with higher mortality (12.9% vs 8.3%, p = 0.078) in the trough level monitoring group compared to the AUG guided group and the latter had 54% less incidence of AKI (OR 0.46, 95% CI [0.31–0.69) [22]. Retrospective cohort by Ishigo T et al., (2024) supported with a comparison analysis which showed that high-AUC group, intermediate-AUC group and low-AUC group had different AKI rates (42.9%, 28.0%, 6.5%, respectively) [23]. A meta-analysis by Yang W et al (2024) revealed that vancomycin trough concentration (Ctrough) were indicators for nephrotoxicity (OR 2.193; 95% CI 1.582–3.442, p Less than 0.001) and Ctrough 10–20 mg/L was equivalent with a mean AUC24 within 400–600 mg·h/L in most patients (92.3%). The conclusion was that the observed trough level, Ctrough, should remain a beneficial tool of monitoring for VA-AKI [24].
Kim T et al (2015) reassured with their findings that vancomycin monotherapy in hemodynamically stable non-critically ill patients had significantly lower nephrotoxicity (OR 0.14, 95 % CI 0.04–0.52, p = 0.004) compared to the combined Vancomycin/Piperacillin-Tazobactam group and the overall incidence was 11.8% [25]. In 2018, Luther MK et al declared that Piperacillin-Tazobactam and vancomycin combined therapy. had a significantly higher risk of VA-AKI than vancomycin monotherapy (OR 3.40; 95% CI, 2.57–4.50 [26]. A comprehensive review by Blair M et al., (2021) proposed the potential pathogenesis of Vancomycin Piperacillin-Tazobactam (VPT) induced AKI as multifactorial including tubular toxicity, oxidative stress, cast formation, acute interstitial nephritis and inhibition of tubular creatinine secretion [27]. Apart from Piperacillin-Tazobactam, concomitant use of cephalosporin (OR 1.55, 95% CI 1.08-2.21, p = 0.017), carbapenems (OR 1.46, 95% CI 1.11-1.91, p = 0.006) with vancomycin also had an increased risk of VA-AKI, according to a longitudinal study [2]. Documented factors with their odds for VA-AKI are demonstrated collectively in the Forest plot [Fig. 2]. A matched case-control study by Gyamlani G et al (2019) (n=33,527) revealed similar or even less odds ratio in the vancomycin group with trough level ≤20 mg/L compared to the linezolid/daptomycin group. However, when vancomycin levels > 20 mg/L, a 4-fold higher risk of AKI was observed, compared to vancomycin levels 2Less than 10 mg/L [28]. The studies which mainly focused on the risk of VA-AKI are collectively shown in the table (Table 2) and epidemiologic errors of the selected studies are summarized in table 1 & 2.
| Author, year, [Ref #] | Aim | Study population | Study Design | Country (number of study) | Outcome Variables | Main Findings | Epidemiological errors |
Ray, A. S et al 2016 [14] | To determine the risk of AKI attributable to intravenous vancomycin | 4033 from 7 RCTs and 7 cohort | Systematic review and meta-analysis | USA (7) Japan (2) Spain (2) Croatia (1) China (1) England (1) | VA-AKI | Vancomycin treatment is associated with a higher risk of AKI, with a relative risk of 2.45 | Seven RCTs were included which minimized the bias. Combining RCTs and cohort studies in a meta-analysis introduced selection bias. |
Kim, J.Y et al 2022 [15] | To evaluate the risk factors for vancomycin-associated acute k8idney injury (AKI) incidence | 53 studies; 31 cohort & 22 case-control studies with sample size ranged from 50 to 3719 | Systematic review and meta-analysis | USA (26) China (10) Japan (6) Australia (4) Korea (2) Belgium (1) Brazil (1) Canada (1) France (1) New Zealand (1) | Risk factors for VA-AKI | Black race (OR 1.47, 95% CI: 1.16–1.87), and Obesity (OR 1.46, 95% CI: 1.12–1.90) were significantly related to vancomycin-associated AKI | Meta-analysis provides a broad scope of evidence, making the findings more robust and generalizable. The association between race (Black vs. Caucasian) and AKI may reflect underlying disparities. Confounding bias related to socioeconomic factors or co-morbid conditions is there. |
Hanrahan, T et al 2015 [18] | To evaluate the potential consequences of more aggressive vancomycin therapy | 1430 critically ill-patients | Retrospective cross-sectional study | England (1) | VA-AKI | Higher serum vancomycin concentrations and greater duration of therapy are independently associated with increased odds of nephrotoxicity.
| The study provides insights that are directly relevant to clinicians aiming to balance efficacy with safety in high-risk populations. The single-center study from an ICU in Birmingham, UK, limits generalization. |
Aljefri, D.M et al 2019 [19] | To analyze the relationship between vancomycin area under the concentration-time curve (AUC) and acute kidney injury (AKI) | 2491 from 8 Randomized cohort and case-control studies | Systematic review and meta-analysis | USA (5) USA-Singapore (1) Australia (1) Japan (1) | AKI | AUCs measured in the first or second 24 hours and lower than approximately 650 mg × hour/L may result in a decreased risk of AKI. | The study addresses a significant clinical question regarding the relationship between vancomycin’s area under the concentration-time curve (AUC) and acute kidney injury (AKI). Many countries and institutions do not have facility for AUC monitoring severely limits the generalizability. |
Tsutsuura M et al 2021 [21] | To explore the relationship between vancomycin (VCM) monitoring strategies and VCM effectiveness and safety | 8 studies were included in the meta-analysis for effectiveness evaluation, 16 studies were included in the meta-analysis for safety evaluation, and one study was included in both analyses. All studies focused on adult patients with MRSA bacteraemia | Systematic review and meta-analysis | USA (11) Japan (4) Korea (2) Brazil (2) Australia (1) Taiwan (1) China (1)
| Risk of VA-AKI | The incidence of acute kidney injury (AKI) was significantly higher for trough concentrations ≥20 μg/mL compared to those at 15-20 μg/mL (OR 2.39, 95% CI 1.78-3.20). Analysis of the target AUC/MIC showed significantly lower treatment failure rates for high AUC/MIC (cut-off 400 ± 15%) (OR 0.28, 95% CI 0.18-0.45). The safety analysis revealed that high AUC value (cut-off 600 ± 15%) significantly increased the risk of AKI (OR 2.10, 95% CI 1.13-3.89). | This systematic review analyzes the relationship between vancomycin monitoring strategies (trough and AUC/MIC) and clinical outcomes, providing valuable insights into both effectiveness and safety. The generalizability of these studies is limited for the countries which have lack of facilities for monitoring. |
Yang W et al 2024 [24] | The area under the curve over 24 h (AUC24) and trough concentrations (Ctrough), and their relationship with both nephrotoxicity and efficacy | 100 publications on nephrotoxicity, 29 focused on AUC24 and 97 on Ctrough, while 74 publications on efficacy, 27 reported AUC24/MIC and 68 reported Ctrough. | Systematic review and meta-analysis | USA (46) Japan (20) China (12) Korea (4) Canada (3) France (2) Israel (2) Australia (2) Thailand (1) Qatar (1) Singapore (1) Poland (1) Saudi Arabia (1) Brazil (1) England (1) Spain (1) Iran (1) | Nephrotoxicity and efficacy of vancomycin in relationship with AUC24 and target Ctrough | There was a significant association between nephrotoxicity and vancomycin C-trough (odds ratio = 2.193; 95% CI 1.582–3.442, p Less than0.001). 92.3% of the groups with a mean AUC24 within 400–600 mg·h/L showed a mean Ctrough of 10–20 mg/L. Monitoring vancomycin Ctrough remains a beneficial tool. | A very comprehensive meta-analysis which demonstrated the relationship between vancomycin pharmacokinetic indicators (AUC24 and Ctrough). The un-matched comparison with much smaller number of studies on AUC24 to many studies on Ctrough on nephrotoxicity, leading to less robust conclusions about the role of AUC24 in clinical practice. Lack of such facilities in many countries limits the generalization. |
Gyamlani, G et al 2019 [28] | To determine the association of vancomycin with acute kidney injury (AKI) in relation to its serum concentration value and to examine the risk of AKI | 33,527 US Veterans 33,527 patients who received either intravenous vancomycin (n = 22,057) or non-glycopeptide antibiotics (linezolid/daptomycin, n = 11,470) | Matched case-control study | USA (1)
| AKI | The odds of AKI were similar or lower in patients receiving vancomycin compared to non-glycopeptide antibiotics when serum vancomycin levels were ≤20 mg/L. [OR, 1.1 (1.1–1.2), 1.2 (1–1.4) and 1.4 (1.1–1.7), respectively] | Being a matched cohort, the study offers a valuable comparison to assess the specific impact of vancomycin on AKI risk. However, the study uses data exclusively from U.S. veterans, limits generalizability and causes selection bias.
|
Table 2: Eligible Journal Articles which mainly focused on the risk of VA-AKI
VA-AKI, Vancomycin Associated Acute Kidney Injury; USA, United States of America, VCM, Vancomycin; AUC, Area Under Curve; MIC, Minimum Inhibitory Concentration, AUC24, The area under the curve over 24 hours; Ctrough, trough concentrations; MRSA, Methicillin Resistant Staphylococcus Aureus
Figure 2: Forest plot demonstrating the odds ratio and factors associated with AKI after intravenous vancomycin usage
The incidence of Vancomycin Associated Acute Kidney Injury varies according to age, race, pharmacokinetics of vancomycin and personal fitness. Reports on VA-AKI surged around the time of 2012 [1,3,4,17], which was thought to be due to higher target levels of Vancomycin. [29] The trend of the VA-AKI had apparently increased with recommended trough levels or AUC/MIC ratios. The incidence was as high as 15.8% among elderly hospitalized patients in China [6] and 15.4% among ICU patient in USA [3]. Based on these reports, the vancomycin consensus guidelines committee revised in 2020 with a recommendation of target AUC/MIC ratio of 400–600 mg*hour/L to prevent treatment failure and to ensure the safety for the treatment in severe MRSA [30]. However, countries with limited-resource settings were not able to adhere to these guidelines. Although Kim J.Y et al [15]. reported a higher risk of VA-AKI among blacks, reports from regions of black preponderance, such as Africa and the Caribbean, were scarce which indicates the study had a reduced external validity with possible selection bias and confounding by disparities in healthcare access or different baseline health conditions.
Many reports recognized initial trough level ≥15 mg/L or > 4 G/day as risk factors of VA-AKI. Further analysis revealed that the trough (>20 µg/mL) or target AUC/MIC ratio value cut-off > 600 mg·h/L were the strong risk factors for VA-AKI [2, 16-24]. On the other hand, lower trough level and AUC were associated with lower risk of VA-AKI. Suggestion by Bruniera, F. R et al (2015) to use adequate dosage for a shorter duration of therapy was quite agreeable to minimize treatment failure and toxicity [31]. The statement in 2019 by Gyamlani G et al, in which the risk of AKI with intravenous vancomycin monotherapy was not higher than other antimicrobial combined therapy unless vancomycin trough level reached beyond 20 µg/dL, reassured vancomycin prescribers [28]. Collectively, findings suggested that risk of VA-AKI could be minimized with lenient monotherapy.
It is important to be aware that more risk factors have been emerging. A retrospective study in 2014 mentioned that hypertension (74 vs. 51 %, p = 0.0009, OR 2.74, 95 % CI 1.5-5.0), furosemide use (65 vs. 39 %, p = 0.0009, OR 2.91, 95 % CI 1.64-5.15) and trough concentration ≥16.2 μg/mL (OR 2.33, 95 % CI 1.25-4.44) were associated with VA-AKI independently [32]. More risk factors were introduced by Qin, X et al (2020) in a retrospective cohort in which the different trough levels [OR of 15.1~20.0 level: 2.50 (95%CI 2.13, 2.93), OR of > 20.0 level: 3.89 (95%CI 3.34, 4.53, respectively), respiratory failure (OR 1.38; 95% CI 1.22, 1.58), chronic renal failure (OR 3.17; 95% CI 2.72, 3.70) and congestive heart failure (OR 1.56; 95% CI 1.37,1.79, concomitant diuretics (OR 1.71; 95% CI 1.51,1.94), PTZ (OR 1.39; 1.24, 1.57) and meropenem (OR 1.29; 95% CI 1.16,1.45), were found to have higher risk of VA-AKI [33]. Categorizing the risk factors into modifiable and non-modifiable factors by Kan WC et al in 2022 was also beneficial [34]. Focus on modifiable risk factors like intravascular volume depletion and acute severe illnesses should be maximized. Unfortunately, non-modifiable risks such as older age, female gender, black race, drug allergy, pre-existing comorbidities, end organ failures (cardiac, renal, liver), diabetes, immunocompromised state and obesity would remain untouchable.
Concerns should be raised for the countries with limited-resource settings where recommended trough levels or AUC/MIC ratios were not applicable and the vulnerability of those patients on conventional therapy remained questionable. The safety of vancomycin at these healthcare services should be explored more. To our knowledge, these institutions relied on the website calculator https://clincalc.com/Vancomycin/ [35], drug prescribing insert or infectious disease specialist guidance to use intravenous vancomycin. The suggestion made by Kunming P et al (2022) to seek pharmacist intervention prior to the intravenous vancomycin is quite reasonable for resource-limited countries.
Studies and systematic reviews have been reported mainly from resource-rich countries. Recommendations were impressive but the generalization was limited, and selection bias were there. We recommend the availability of Vancomycin trough levels for any users in clinical practice especially for high-risk patients.
The incidence of VA-AKI varies widely from 7.3% to 15.8%, according to the samples selected and associated risk factors. Some findings and recommendations had selection bias and decreased generalization. Reports were mainly from resource-rich countries. Correction of modifiable risks, vancomycin monotherapy, consulting infectious disease specialists and pharmacists in advance seem useful tools to control VA-AKI regardless of resource settings.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
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Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
