{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T08:07:05Z","timestamp":1793779625354,"version":"4.6.1"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vancomycin dosing in critically ill patients typically requires monitoring the area under the concentration-time curve\/minimum inhibitory concentration (AUC\/MIC), often using at least two vancomycin levels (VLs). However, the optimal number of VLs needed for accurate AUC\/MIC estimation in this population remains uncertain. This study aimed to determine the minimum number of VLs required to accurately estimate the AUC\/MIC in critically ill patients treated with intermittent infusion of vancomycin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A prospective cohort study was conducted in critically ill patients, where VLs were obtained at peak, beta, and trough phases. Five AUC estimates were derived using PrecisePK\n                      <jats:sup>\u2122<\/jats:sup>\n                      , a Bayesian software: AUC-1 [peak, beta (2\u202fh after the end infusion), trough], AUC-2 (beta, trough), AUC-3 (peak, trough), AUC-4 (trough), and AUC-5 (only Bayesian prior, without VL). These estimates were compared for accuracy and bias (mean \u00b1 SEM) against the reference AUC calculated via the trapezoidal model (AUC\n                      <jats:sub>Ref<\/jats:sub>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We enrolled 36 adult patients with age of 65 (52\u201377) years, moderate severity [APACHE II 10 (5\u201314) and SOFA 5 (4\u20136)], 6 of them in ECMO and 4 in renal replacement therapy. A total of 108 blood samples for VL were analyzed. The AUC-3 (0.976\u202f\u00b1\u202f0.012) showed greater accuracy compared to AUC-4 (1.072\u202f\u00b1\u202f0.032,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.042) and AUC-5 (1.150\u202f\u00b1\u202f0.071, p\u202f=\u202f0.042). AUC-3 also demonstrated lower bias (0.053\u202f\u00b1\u202f0.009) than AUC-4 (0.134\u202f\u00b1\u202f0.026,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.036) and AUC-5 (0.270\u202f\u00b1\u202f0.060,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003). Bland\u2013Altman analysis indicated better agreement between AUC-3 and AUC-2 with AUC\n                      <jats:sub>Ref<\/jats:sub>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bayesian software using two vancomycin levels provides a more accurate and less biased AUC\/MIC estimation in critically ill patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1575224","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T05:30:00Z","timestamp":1753162200000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Vancomycin levels for Bayesian dose-optimization in critical care: a prospective cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Natalia","family":"Dreyse","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Salazar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M.","family":"Munita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Rello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9","family":"L\u00f3pez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1093\/ajhp\/zxaa036","article-title":"Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists","volume":"77","author":"Rybak","year":"2020","journal-title":"Am J Health Syst Pharm"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1016\/j.jiac.2023.04.018","article-title":"Effect of renal clearance on vancomycin area under the concentration-time curve deviations in critically ill patients","volume":"29","author":"Ishigo","year":"2023","journal-title":"J Infect Chemother"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1097\/FTD.0000000000001075","article-title":"Area-under-curve-guided versus trough-guided monitoring of vancomycin and its impact on nephrotoxicity: a systematic review and meta-analysis","volume":"45","author":"Lim","year":"2023","journal-title":"Ther Drug 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Syst Pharm"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.ijantimicag.2018.12.014","article-title":"The dosing and monitoring of vancomycin: what is the best way forward?","volume":"53","author":"Drennan","year":"2019","journal-title":"Int J Antimicrob Agents"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1007\/s13318-019-00551-1","article-title":"Clinical and pharmacokinetic outcomes of peak-trough-based versus trough-based vancomycin therapeutic drug monitoring approaches: a pragmatic randomized controlled trial","volume":"44","author":"Al-Sulaiti","year":"2019","journal-title":"Eur J Drug Metab Pharmacokinet"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1002\/phar.2234","article-title":"Conversion from vancomycin trough concentration-guided dosing to area under the curve-guided dosing using two sample measurements in adults: implementation at an Academic Medical Center","volume":"39","author":"Meng","year":"2019","journal-title":"Pharmacotherapy"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e02042-17","DOI":"10.1128\/AAC.02042-17","article-title":"Prospective trial on the use of trough concentration versus area under the curve to determine therapeutic vancomycin dosing","volume":"62","author":"Neely","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1186\/s12879-021-05858-6","article-title":"The monitoring of vancomycin: a systematic review and meta-analyses of area under the concentration-time curve-guided dosing and trough-guided dosing","volume":"21","author":"Tsutsuura","year":"2021","journal-title":"BMC Infect Dis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1111\/cts.13210","article-title":"Pharmacokinetic equations versus Bayesian guided vancomycin monitoring: pharmacokinetic model and model-informed 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