J Korean Med Sci.  2023 Apr;38(14):e101. 10.3346/jkms.2023.38.e101.

Evaluation of Vancomycin TDM Strategies: Prediction and Prevention of Kidney Injuries Based on Vancomycin TDM Results

  • 1Department of Clinical Pharmacology and Therapeutics, Seoul National University Hospital, Seoul National University College of Medicine Seoul, Korea
  • 2Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
  • 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 4Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  • 5Department of Clinical Pharmacology and Therapeutics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea


The current guidelines for therapeutic drug monitoring (TDM) of vancomycin suggest a target 24-hour area under the curve (AUC 0-24 ) of 400 to 600 mg*h/L for serious methicillinresistant Staphylococcus aureus infections. In this study, the predictabilities of acute kidney injury (AKI) of various TDM target parameters, target levels, and sampling methods were evaluated in patients who underwent TDM from January 2020 to December 2020. The AUC 0-24 and trough values were calculated by both one- and two-point sampling methods, and were evaluated for the predictability of AKI. Among the AUC 0-24 cutoff comparisons, the threshold value of 500 mg*h/L in the two sampling methods was statistically significant (P = 0.042) when evaluated for the predictability of AKI. Analysis by an receiver operating characteristic curve estimated an AUC 0-24 cutoff value of 563.45 mg*h/L as a predictor of AKI, and was proposed as the upper limit of TDM target.


Vancomycin; Therapeutic Drug Monitoring; Acute Kidney Injury; Pharmacokinetics


  • Fig. 1 Vancomycin daily AUC0-24 and the ratio of creatinine change to baseline calculated by one- and two-point estimation. Each plot was stratified by AUC0-24 levels of (A, B) 500, (C, D) 600, and (E, F) 700 mg∙h/L. The P values represent Mann–Whitney U test results.AUC0-24 = area under the curve over 24 hours.

  • Fig. 2 ROC curve for estimation of (A, B) AUC0-24 and (C, D) trough cutoff values for AKI prediction. The AUC shown in the figure represents the area under the ROC curve.ROC = receiver operating characteristic, AUC0-24 = area under the curve over 24 hours, AKI = acute kidney injury.


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