Initial cumulative area under the blood concentration-time curve of vancomycin is associated with the incidence of acute kidney injury

We aimed to evaluate the relationship between the cumulative area under the concentration-time curve (AUC) for the first and second day of vancomycin (VCM) administration and acute kidney injury (AKI). The primary outcome was the cumulative incidence of AKI. Patients were divided into three groups based on the measured AUC_{0-48 h} at the first therapeutic drug monitoring (TDM) (800 to less than 1000 µg·h/mL, Low-AUC group; 1000 to less than 1200 µg·h/mL, Moderate-AUC group; ≥1200 µg·h/mL, High-AUC group). Among 180 enrolled patients, 29 (16.1%) developed AKI. In the multivariate Cox proportional hazard analysis, the Moderate- (hazard ratio [HR]: 5.7, 95% confidence interval [CI]: 2.24-14.44) and High- (HR: 11.0, 95% CI: 3.88-31.39) AUC groups were associated with a higher incidence of AKI compared to the Low-AUC group. The accumulation toxicity of VCM was observed, and the cumulative AUC_{0-48 h} was associated with the development of AKI.