Objective  To explore the relationship between vancomycin therapeutic drug monitoring(TDM) and short-term and long-term prognosis in patients with sepsis.

Methods  Clinical data of sepsis patients treated in the intensive care unit were obtained from the MIMIC-IV database. Patients were divided into the TDM group and the non-TDM group based on the status of vancomycin TDM.A 1 ∶ 1 propensity score matching (PSM) was employed. The association between vancomycin TDM and the risk of 28  d and 90 d mortality of patients before and after PSM was analyzed using Kaplan-Meier survival curves and multivariate Cox regression models. Meanwhile, the relationship between vancomycin TDM and the risk of mortality within 28 d and 90 d was investigated.

Results  A total of 3,525 patients were included,with 2,474 in the TDM group and 1,051 in the non-TDM group. After PSM, 848 patients were included in each group. The mortality rates at 28 d and 90 d in the TDM group were lower than those in the non-TDM group both before and after PSM (P<0.005). The Kaplan-Meier curve results showed that the survival rates at 28 d and 90 d in the TDM group were higher than those in the non-TDM group both before and after PSM (P<0.001). Multivariate COX regression analysis showed that vancomycin TDM was an independent protective factor against mortality risk at 28 d [HR=0.74, 95%CI (0.65, 0.84), P<0.001] and 90 d [HR=0.79, 95%CI (0.70, 0.89), P<0.001] in sepsis patients.

Conclusion  Vancomycin TDM reduces the short-term and long-term mortality risk in sepsis patients and is worthy of clinical promotion and application.

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