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Vancomycin exposure parameters, including the 24-hour area under the concentration\u2013time curve (AUC\u2080\u2013\u2082\u2084, day 1) and steady-state AUC (AUCss), were retrospectively estimated using Bayesian modeling software and were not used to guide dose adjustment during patient care. The primary outcome was 30-day all-cause mortality, and secondary outcomes included microbiological failure and nephrotoxicity defined according to KDIGO criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 120 patients with EIE were included. The optimal cut-points for predicting 30-day survival were an AUC\u2080\u2013\u2082\u2084\/MIC\u2009\u2265\u2009450 and an AUCss\/MIC\u2009\u2265\u2009420. Patients achieving these thresholds had significantly lower 30-day mortality compared with those below the thresholds. Adequate vancomycin exposure remained independently associated with improved survival. A prespecified AUCss\u2009\u2265\u2009650\u00a0mg\u00b7h\/L was associated with increased nephrotoxicity. In multivariate analysis, acute renal failure, septic shock, and low vancomycin AUC\/MIC were independent predictors of 30-day mortality, whereas cardiac surgery demonstrated a protective effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with EIE, achieving AUC\u2080\u2013\u2082\u2084\/MIC\u2009\u2265\u2009450 or AUCss\/MIC\u2009\u2265\u2009420 improves survival, whereas AUCss\u2009\u2265\u2009650\u00a0mg\u00b7h\/L significantly heightens nephrotoxicity risk. Early AUC-guided dose optimization and renal monitoring are crucial for balancing efficacy and safety in this high-risk population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-12993-5","type":"journal-article","created":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T07:16:32Z","timestamp":1772867792000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The optimal target of vancomycin area under the curve in early or later phase on clinical outcomes and nephrotoxicity in patients with enterococcal infective endocarditis: how much is enough?"],"prefix":"10.1186","volume":"26","author":[{"given":"Aimatchara","family":"Worrasan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manat","family":"Pongchaidecha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wichai","family":"Santimaleeworagun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"key":"12993_CR1","unstructured":"Yallowitz AW, Decker LC. 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