{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T22:03:39Z","timestamp":1790201019816,"version":"4.1.0"},"reference-count":35,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Evidence supports vancomycin therapeutic-drug monitoring by area under the concentration-time curve (AUC), but data to establish an AUC upper limit are limited and published nephrotoxicity thresholds range widely. The objective of this analysis was to examine the association between initial vancomycin AUC and nephrotoxicity. This was a multicenter, retrospective cohort study of adult patients receiving intravenous vancomycin from 2014 to 2015. Nephrotoxicity was defined as a serum creatinine increase of 0.5 mg\/liter and 50% from baseline on consecutive measurements. Vancomycin exposure profile during the initial 48 h of therapy was estimated using maximum\n            <jats:named-content content-type=\"genus-species\">a posteriori<\/jats:named-content>\n            probability Bayesian estimation. Vancomycin AUC and minimum-concentration (\n            <jats:italic>C<\/jats:italic>\n            <jats:sub>min<\/jats:sub>\n            ) thresholds most strongly associated with nephrotoxicity were identified via classification and regression tree (CART) analysis. Predictive performances of CART-derived and other candidate AUC thresholds was assessed through positive and negative predictive value and receiver operating characteristic curves. Poisson regression was used to quantify the association between exposure thresholds and nephrotoxicity while adjusting for confounders. Among 323 patients included, nephrotoxicity was significantly higher in patients with AUCs from 0 to 48 h (AUC\n            <jats:sub>0\u201348<\/jats:sub>\n            ) of \u22651,218 mg \u00b7 h\/liter, AUC\n            <jats:sub>0\u201324<\/jats:sub>\n            of \u2265677 mg \u00b7 h\/liter, AUC\n            <jats:sub>24\u201348<\/jats:sub>\n            of \u2265683 mg \u00b7 h\/liter, and day 1\n            <jats:italic>C<\/jats:italic>\n            <jats:sub>min<\/jats:sub>\n            (\n            <jats:italic>C<\/jats:italic>\n            <jats:sub>min24<\/jats:sub>\n            ) of \u226518.8 mg\/liter. Vancomycin exposure in excess of these thresholds was associated with a 3- to 4-fold-increased risk of nephrotoxicity in Poisson regression. The predictive performance of AUC for nephrotoxicity was maximized at daily AUC values between 600 and 800 mg \u00b7 h\/liter. Although these data support an AUC range for vancomycin-associated nephrotoxity rather than a single threshold, available evidence suggests that a daily AUC limit of 700 mg \u00b7 h\/liter is reasonable.\n          <\/jats:p>","DOI":"10.1128\/aac.01684-17","type":"journal-article","created":{"date-parts":[[2017,10,30]],"date-time":"2017-10-30T15:50:33Z","timestamp":1509378633000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":110,"title":["Identification of Vancomycin Exposure-Toxicity Thresholds in Hospitalized Patients Receiving Intravenous Vancomycin"],"prefix":"10.1128","volume":"62","author":[{"given":"Evan J.","family":"Zasowski","sequence":"first","affiliation":[{"name":"Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA"},{"name":"Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle P.","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Huron Valley Sinai Hospital, Commerce Charter Township, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trang D.","family":"Trinh","sequence":"additional","affiliation":[{"name":"Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA"},{"name":"Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie A.","family":"Finch","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Detroit Receiving Hospital, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M.","family":"Pogue","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Sinai-Grace Hospital, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan P.","family":"Mynatt","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Detroit Receiving Hospital, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Rybak","sequence":"additional","affiliation":[{"name":"Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA"},{"name":"Department of Pharmacy Services, Detroit Receiving Hospital, Detroit, Michigan, USA"},{"name":"Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01653-13"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu398"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01485-12"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.03970-14"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000295"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkn080"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00591-16"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/aac.01293-17"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp080434"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01568-12"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X1504300507"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2012.10.015"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2015.09.010"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1086\/600884"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1159\/000343162"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piu110"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02535-16"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1086\/511640"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/468987"},{"key":"e_1_3_2_21_2","volume-title":"Antimicrobial use in Australian hospitals: 2014 annual report of the National Antimicrobial Utilisation Surveillance Program","author":"Australian Commission on Safety and Quality in Health Care","year":"2015","unstructured":"Australian Commission on Safety and Quality in Health Care. 2015. 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