Park Hye Young, Kim Bo Young, Song Joon Young, Seo Kyung Hee, Lee So Hyun, Choi Seeun, Rhew Kiyon
Department of Pharmacy, Korea University Guro Hospital, Seoul 08308, Republic of Korea.
Division of Infectious Disease, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea.
J Clin Med. 2025 Mar 10;14(6):1863. doi: 10.3390/jcm14061863.
: Vancomycin therapeutic drug monitoring (TDM) has traditionally relied on trough concentrations; however, recent guidelines recommend area under the curve (AUC)-based monitoring due to its potential to improve efficacy and safety. Limited studies have evaluated the impact of AUC-based dosing on clinical outcomes, particularly in South Korea. : This single-center retrospective cohort study compared the incidence of acute kidney injury (AKI) and total vancomycin usage between patients receiving TDM based on AUC versus trough concentrations. Propensity score matching was applied to balance baseline characteristics, including age, sex, body weight, renal function, and concomitant nephrotoxic medication use. The study analyzed data from adult patients with normal renal function treated between 2021 and 2023. : After propensity score matching, AKI incidence was significantly lower in the AUC-based group (1.20%) compared to the trough-based group (5.08%) (odds ratio 0.23, 95% CI: 0.09-0.59, = 0.0021). Although no significant differences were observed in treatment duration or dose adjustments, the total administered vancomycin dose was significantly reduced in the AUC-based group. This reduction likely contributed to lower AKI rates and decreased unnecessary drug exposure. : Compared to trough-based dosing, AUC-based vancomycin dosing significantly reduced AKI incidence and total drug usage in adult patients with normal renal function. These findings underscore the importance of adopting AUC-based TDM in clinical practice to enhance patient safety and optimize vancomycin therapy. Further studies are needed to evaluate the broader implementation of AUC-based monitoring in diverse clinical settings.
万古霉素治疗药物监测（TDM）传统上依赖于谷浓度；然而，最近的指南推荐基于曲线下面积（AUC）的监测，因为它有可能提高疗效和安全性。有限的研究评估了基于AUC给药对临床结局的影响，特别是在韩国。
这项单中心回顾性队列研究比较了接受基于AUC与谷浓度的TDM的患者之间急性肾损伤（AKI）的发生率和万古霉素总使用量。应用倾向评分匹配来平衡基线特征，包括年龄、性别、体重、肾功能和同时使用的肾毒性药物。该研究分析了2021年至2023年期间治疗的肾功能正常的成年患者的数据。
倾向评分匹配后，基于AUC的组中AKI发生率（1.20%）显著低于基于谷浓度的组（5.08%）（优势比0.23，95%CI：0.09-0.59，P = 0.0021）。虽然在治疗持续时间或剂量调整方面未观察到显著差异，但基于AUC的组中万古霉素的总给药剂量显著降低。这种降低可能导致AKI发生率降低和不必要的药物暴露减少。
与基于谷浓度的给药相比，基于AUC的万古霉素给药显著降低了肾功能正常的成年患者的AKI发生率和总药物使用量。这些发现强调了在临床实践中采用基于AUC的TDM以提高患者安全性和优化万古霉素治疗的重要性。需要进一步的研究来评估基于AUC的监测在不同临床环境中的更广泛实施。
