{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:21:39Z","timestamp":1787167299943,"version":"build-2736575974"},"reference-count":15,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Intravenous vancomycin is a mainstay for prosthetic joint infections, osteomyelitis, and implant-associated infections, yet real-world dosing frequently misses PK\/PD targets. We assessed whether a ward-embedded standard operating procedure (SOP) improves target attainment and dosing efficiency. Methods: Single-centre, non-randomized pre-post study in an orthopedic service. SOP mandated weight-adapted loading dose, renal function-adjusted maintenance dosing, a 15\u201320 mg\/L trough target, and scheduled TDM. Adults receiving \u226572 h IV vancomycin were included; major renal failure and incomplete TDM were excluded. Pre-SOP data were retrospective; post-SOP data were prospective (03\/2024\u201306\/2025). Primary outcome: proportion of troughs within 15\u201320 mg\/L (first and repeated). Repeated measures were modeled with GEE. Time to first in-range trough used Kaplan\u2013Meier (indexed by measurement number). Results: We included 154 patients (pre-SOP n = 58; post-SOP n = 96); baseline characteristics were broadly similar. Use of a weight-based loading dose rose from 31.0% pre-SOP to 100% post-SOP (p &lt; 0.001). At the first trough, 17.2% vs. 26.0% were within 15\u201320 mg\/L (p = 0.238). Across 847 troughs (pre = 319; post = 528), the in-range proportion increased from 28.2% to 41.7%, with subtherapeutic values declining from 38.2% to 26.3% and supratherapeutic values remaining nearly similar (33.5% \u2192 32.0%). Time to first in-range trough shortened from a median of 4 to 2 measurements (log-rank p &lt; 0.001). Post-SOP measurements had higher odds of being in range (aOR 1.68, 95% CI 1.29\u20132.20; p &lt; 0.001), with marginal predicted probabilities of 33.4% (pre) vs. 47.8% (post). Dose adjustments per patient decreased from a mean 4.0 to 2.48 (p &lt; 0.001). Conclusions: A pragmatic, orthopedic ward\u2013embedded SOP for intravenous vancomycin improved pharmacologic precision: more measurements within target, fewer subtherapeutic exposures, faster target attainment, and fewer dose changes. These data support protocol-first implementation as an immediately actionable step toward more consistent vancomycin exposure in orthopedic care. Future work should integrate AUC-guided, model-informed precision dosing and evaluate clinical endpoints and generalizability across centres.<\/jats:p>","DOI":"10.3390\/antibiotics14111087","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T14:29:34Z","timestamp":1761661774000},"page":"1087","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Implementing a Standard Operating Procedure Is Associated with Improved Vancomycin Target Attainment in Bone and Joint Infections: A Pre-Post Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Moritz","family":"Diers","sequence":"first","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliane","family":"Beschauner","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Felsberg","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Isabell","family":"Kossack","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, Martin Luther University Halle-Wittenberg, Magdeburger Str. 16, 06108 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Zeh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4691-3588","authenticated-orcid":false,"given":"Karl-Stefan","family":"Delank","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Gutteck","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3309-6260","authenticated-orcid":false,"given":"Felix","family":"Werneburg","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1007\/s11999-010-1308-6","article-title":"Revision Total Knee Arthroplasty Infection: Incidence and Predictors","volume":"468","author":"Mortazavi","year":"2010","journal-title":"Clin. 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