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Vancomycin Exposure Dynamics and Clinical Outcomes in Critically Ill Patients: A Retrospective Cohort Study
Mohamad Amer Nashtar1, Jutta Dedy2, Stamatina Georgitsi1
1Ruhr University Bochum, Knappschaft Kliniken University Hospital Bochum, Department of Medicine, 44892 Bochum, Germany.
Antibiotics (Basel, Switzerland)
|June 26, 2026
Summary
Vancomycin dosing in the ICU is complex. High trough concentrations (>15 mg/L) linked to mortality and kidney injury, while lower troughs may indicate sub-optimal treatment, suggesting limitations of current monitoring methods.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Nephrology
Background:
- Vancomycin is essential for severe Gram-positive infections but has a narrow therapeutic index.
- Traditional trough monitoring may not fully capture vancomycin exposure.
- Augmented renal clearance (ARC) in Intensive Care Unit (ICU) patients complicates vancomycin dosing.
Purpose of the Study:
- To evaluate trough-based vancomycin exposure metrics.
- To assess the association of these metrics with ICU mortality and acute kidney injury (AKI).
Main Methods:
- Retrospective analysis of 109 ICU patients with sepsis receiving vancomycin.
- Exposure assessed by mean trough concentrations, time in therapeutic range (TIR), and volatility index (SD/mean).
- Outcomes analyzed using multivariable regression and restricted cubic splines.
Main Results:
- Time in therapeutic range (TIR) >15 mg/L associated with increased mortality and AKI.
- Higher mean troughs correlated with AKI; higher volatility inversely associated with adverse outcomes.
- ARC predicted subtherapeutic exposure (TIR <10 mg/L).
Conclusions:
- Sustained vancomycin troughs >15 mg/L linked to mortality and nephrotoxicity.
- Optimal outcomes may occur within a narrow trough range (8-12 mg/L), requiring validation.
- Trough-based metrics have limitations; further research needed for improved vancomycin monitoring in ICUs.
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