ArticleBMC anesthesiology2026
Guideline-informed vancomycin therapeutic drug monitoring indications in an adult intensive care unit: a retrospective descriptive study.
Article in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundVancomycin is widely used in intensive care units (ICUs) for severe Gram-positive infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). Because critically ill patients have high pharmacokinetic variability and toxicity risk, therapeutic drug monitoring (TDM) is recommended in selected high-risk conditions. However, real-world data quantifying guideline-informed TDM eligibility in ICUs where TDM is not available remain limited. This study aimed to estimate the burden and criterion-level profile of TDM eligibility among adult ICU patients receiving vancomycin.
methodsA retrospective descriptive study was conducted in an adult ICU between January 1, 2024, and July 1, 2025. TDM eligibility was assessed using guideline-derived domains from the 2020 IDSA/ASHP/PIDS/SIDP consensus recommendations, operationalized for retrospective ICU assessment. Because vancomycin TDM was not performed during the study period, drug concentrations, area under the curve (AUC) estimates, target attainment, and TDM-guided dose modifications were unavailable. Data were summarized descriptively, and between-group comparisons were performed using chi-square test, Fisher's exact test, and Mann-Whitney U test, as appropriate.
resultsDuring the study period, 341 of 1894 ICU admissions (18.0%) involved vancomycin therapy, and 331 patients were included in the final analysis. Overall, 319 patients (96.4%) met at least one TDM indication criterion. The most frequent indications were prolonged therapy, defined as observed treatment duration exceeding 5 days during the treatment course (276, 83.4%), altered pharmacokinetics (227, 68.6%), renal dysfunction (180, 54.4%), nephrotoxic co-administration (174, 52.6%), and serious or invasive MRSA infection (25, 7.6%). Indications frequently overlapped, with a median of 3 (IQR: 2-4) criteria per patient.
conclusionNearly all vancomycin-treated ICU patients met guideline-informed TDM eligibility criteria, indicating a substantial burden of monitoring eligibility in this Turkish ICU where TDM was not available. These findings primarily inform local resource planning, but may also be relevant to institutions with similar reimbursement, laboratory, or infrastructure constraints. Prospective pre-post implementation studies should evaluate target attainment, nephrotoxicity, clinical outcomes, and costs.
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