Effects of AUC-Based Vancomycin Therapeutic Drug Monitoring on AKI Incidence and Drug Utilization: A Propensity Score-Weighted Analysis

Background: 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. Methods: 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. Results: 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, p = 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. Conclusions: 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.