Retrospective Evaluation of Vancomycin Monitoring in Chinese Adults with Gram-Positive Coccal Infections

Objective:This study conducted therapeutic drug monitoring (TDM) to compare the clinical value of two pharmacokinetic/pharmacodynamic (PK/PD) parameters for vancomycin therapy, namely trough concentration (10-20 mg/L) and AUC 0-24h /MIC (400-650 mg·h·L -1 ), in Chinese patients. Methods: A total of 103 adult patients were enrolled in this study. All patients underwent trough concentration monitoring, and 87 of them completed the AUC 0-24h /MIC assessment. The target attainment rates of the two parameters were compared, and their correlations with clinical outcomes and safety were analyzed. Results: The results showed that 40.78% (42/103) of patients attained the target trough concentration range, while 39.08% (34/87) reached the target AUC 0-24h /MIC threshold, with no statistically significant difference between these attainment rates ( χ 2 = 0.008, P = 0.929). The overall clinical efficacy rate of vancomycin treatment for Gram-positive coccal infections was 88.35%, with a microbiological eradication rate of 93.20% and an incidence of acute kidney injury (AKI) of 5.83%. Further analysis showed that neither of the two PK/PD parameters was significantly associated with clinical outcomes ( P > 0.05). Conclusion: This study found no significant association between vancomycin PK/PD parameters (trough concentration and AUC 0-24h /MIC) and clinical efficacy or microbiological eradication in Chinese patients. Notably, pharmacokinetic parameters showed potential clinical value in predicting vancomycin-associated nephrotoxicity. Given the weak correlation between current therapeutic targets and clinical outcomes, it is recommended to further validate this through large-scale, multicenter prospective cohort studies.