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Therapeutic drug monitoring using area under the concentration\u2013time curve (AUC)\u2013guided dosing is recommended to optimize therapy and prevent vancomycin\u2010associated nephrotoxicity (VAN). In 2018, a consultative therapeutic drug monitoring Advisory Service (the Service) was piloted at an Australian hospital to enable AUC\u2010guided vancomycin dosing. This study sought to compare the incidence of VAN pre\u2010 and post\u2010Service implementation. A 4\u2010year retrospective observational study of intravenous vancomycin therapy (greater than 48 hours) in adults (aged 18 years or older), spanning 3 years before and 1\u2010year after implementation of the Service was undertaken. Nephrotoxicity was defined as an increase in serum creatinine concentrations of 26.5 \u03bcmol\/L or greater or 50% or more from baseline, on 2 or more consecutive days. Univariate analysis was performed to compare patients before and after implementation, and with and without VAN. Independent factors associated with VAN were identified using a multivariate model. In total, 971 courses of vancomycin therapy, administered to 781 patients, were included: 764 courses (603 patients) before implementation and 207 courses (163 patients) after implementation. The incidence of VAN decreased by 5% after Service implementation (15% before implementation vs 10% after implementation; <jats:italic>P<\/jats:italic> = .075). Independent factors associated with VAN were sepsis, heart failure, solid\u2010organ transplant, concomitant piperacillin\u2013tazobactam, and average vancomycin AUC during therapy. In conclusion, there was a nonsignificant trend toward a reduced incidence of VAN after the Service. Larger prospective studies are needed to confirm the efficacy of the Service.<\/jats:p>","DOI":"10.1002\/jcph.2363","type":"journal-article","created":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T07:53:28Z","timestamp":1696233208000},"page":"19-29","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The Influence of a Therapeutic Drug Monitoring Service on Vancomycin\u2010Associated Nephrotoxicity"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5916-8228","authenticated-orcid":false,"given":"Jennifer J.","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology and Toxicology St Vincent's Hospital Sydney  NSW Australia"},{"name":"School of Clinical Medicine St Vincent's Healthcare Clinical Campus Faculty of Medicine and Health, UNSW Sydney  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