{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T08:29:59Z","timestamp":1787041799499,"version":"build-2736575974"},"reference-count":23,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background\/Objectives: Vancomycin remains a cornerstone antibiotic for Gram-positive infections, but its narrow therapeutic window and marked pharmacokinetic variability in critical patients complicate dosing. This study aimed to analyze survival and identify factors associated with mortality in intensive care unit (ICU) patients receiving vancomycin under therapeutic drug monitoring (TDM). Methods: A single-center, retrospective cohort study was conducted at City Clinical Hospital named after I.V. Davydovsky (Moscow, Russia) between December 2021 and January 2026 (IRB protocol VANCO-2021). A total of 190 adult patients from surgical, therapeutic, and cardiac ICUs receiving vancomycin for at least 3\u20135 days were analyzed; trough concentrations were determined by HPLC-MS\/MS. Cox proportional hazards, spline Cox, and segmented (piecewise) Cox models were applied to identify mortality predictors, with bootstrap subsampling assessing threshold robustness. Results: Three independent predictors of mortality were identified: ln(minimum vancomycin concentration) (HR = 1.644, p = 0.028), age (HR = 1.019, p = 0.037), and serum creatinine (HR = 1.004, p &lt; 0.001). A data-driven threshold trough concentration (Ctrough) of 25.5 \u00b5g\/mL was identified, above which mortality increased substantially (63.0% vs. 26.4%; p &lt; 0.05). The adjusted hazard ratio for Ctrough \u2265 25.5 \u00b5g\/mL was approximately 1.88 (p = 0.054); bootstrap subsampling yielded an uncertainty interval of 23.2\u201333.6 \u00b5g\/mL. Conclusions: Elevated minimum vancomycin concentrations exceeding 25.5 \u00b5g\/mL are independently and statistically associated with increased mortality in ICU patients, likely reflecting altered drug exposure and illness severity rather than a direct causal effect. Systematic TDM is essential for maintaining vancomycin within the therapeutic range.<\/jats:p>","DOI":"10.3390\/ph19081303","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T08:08:41Z","timestamp":1787040521000},"page":"1303","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic Monitoring of Vancomycin and Factors Affecting Survival in ICU Patients with Infections"],"prefix":"10.3390","volume":"19","author":[{"given":"Nadezhda G.","family":"Berdnikova","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology and Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia"},{"name":"Pulmonary Department, City Clinical Hospital Named After I.V. Davydovsky, Moscow 109240, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2978-3371","authenticated-orcid":false,"given":"Dmitry V.","family":"Tsyganko","sequence":"additional","affiliation":[{"name":"Pulmonary Department, City Clinical Hospital Named After I.V. Davydovsky, Moscow 109240, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4544-1825","authenticated-orcid":false,"given":"Vladislav D.","family":"Vasiukov","sequence":"additional","affiliation":[{"name":"Department of Industrial Pharmacy, National Research Nuclear University \u201cMEPhI\u201d, Moscow 115409, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3554-8941","authenticated-orcid":false,"given":"Vladimir S.","family":"Arnautov","sequence":"additional","affiliation":[{"name":"Department of Industrial Pharmacy, National Research Nuclear University \u201cMEPhI\u201d, Moscow 115409, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2472-601X","authenticated-orcid":false,"given":"Aleksei V.","family":"Trofimov","sequence":"additional","affiliation":[{"name":"Laboratory for Radiobiology & Ecology, Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow 119334, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9183-8292","authenticated-orcid":false,"given":"Valerii A.","family":"Menshov","sequence":"additional","affiliation":[{"name":"Laboratory for Radiobiology & Ecology, Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow 119334, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8993-4808","authenticated-orcid":false,"given":"Evgeniy S.","family":"Melnikov","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical and Toxicological Chemistry, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evgenia V.","family":"Shikh","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8526-7147","authenticated-orcid":false,"given":"Susanna S.","family":"Sologova","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, A.P. Nelyubin Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2615-7167","authenticated-orcid":false,"given":"Elena A.","family":"Smolyarchuk","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, A.P. Nelyubin Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6528-1585","authenticated-orcid":false,"given":"Natalia B.","family":"Lazareva","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"82","DOI":"10.2146\/ajhp080434","article-title":"Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists","volume":"66","author":"Rybak","year":"2009","journal-title":"Am. 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