---
title: "Vancomycin AUC24/MIC ≥253 Predicts Early Response in VLBW Neonates With Late-Onset Sepsis"
id: "pubmed-42576192"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42576192"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42576192/"
doi: "10.1097/INF.0000000000005369"
published_at: "2026-08-11T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Vancomycin AUC24/MIC ≥253 Predicts Early Response in VLBW Neonates With Late-Onset Sepsis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42576192
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42576192/)
- **DOI:** [10.1097/INF.0000000000005369](https://doi.org/10.1097%2FINF.0000000000005369)
- **Published At:** 2026-08-11T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study aimed to identify **vancomycin** exposure thresholds linked to early clinical and microbiologic cure in very-low-birth-weight (**VLBW**) neonates with late-onset sepsis (**LOS**). - Multicenter observational cohort included 36 VLBW neonates with confirmed Gram-positive LOS; 27 (75%) achieved early clinical and microbiological cure (ECMC) within 72 hours. - Researchers measured at least one steady-state trough concentration per patient and estimated exposure using AUC24 and trough levels. - A significant correlation existed between **AUC24** and trough concentrations (R2 = 0.568; P < 0.001). - Median AUC24 and trough concentrations were higher in the ECMC group: AUC24 median 257 mg·h/L vs 175 mg·h/L (P = 0.005); trough median 10.2 mg/L vs 5.1 mg/L (P = 0.043). - Classification and regression tree analysis and ROC analysis identified an **AUC24/MIC ≥ 253 mg·h/L** as the optimal threshold associated with ECMC. - The AUC24/MIC threshold demonstrated superior discriminative performance versus trough concentrations (AUC-ROC 0.813 vs 0.726; reported P = 0.005 and P = 0.045 respectively). - Authors conclude AUC24/MIC ≥253 mg·h/L shows better prediction of early response than troughs but recommend prospective validation in larger cohorts. - No funding or conflicts of interest were reported by the authors.
## Clinical Analysis & Structured Key Points
Optimizing Vancomycin Exposure for Early Treatment Response in Very-Low-Birth-Weight Neonates With Late-Onset Sepsis - PubMed This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features! Clipboard, Search History, and several other advanced features are temporarily unavailable. Skip to main page content The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site. The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation Search: Search Advanced Clipboard User Guide Save Email Send to Clipboard My Bibliography Collections Citation manager Display options Display options Format Abstract PubMed PMID Save citation to file Format: Summary (text) PubMed PMID Abstract (text) CSV Create file Cancel Email citation Email address has not been verified. Go to My NCBI account settings to confirm your email and then refresh this page. 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Sunday Monday Tuesday Wednesday Thursday Friday Saturday Report format: Summary Summary (text) Abstract Abstract (text) PubMed Send at most: 1 item 5 items 10 items 20 items 50 items 100 items 200 items Send even when there aren't any new results Optional text in email: Save Cancel Create a file for external citation management software Create file Cancel Your RSS Feed Name of RSS Feed: Number of items displayed: 5 10 15 20 50 100 Create RSS Cancel RSS Link Copy Actions Cite Collections Add to Collections Create a new collection Add to an existing collection Name your collection: Name must be less than 100 characters Choose a collection: Unable to load your collection due to an error Please try again Add Cancel Permalink Permalink Copy Display options Display options Format Abstract PubMed PMID Cite Display options Display options Format Abstract PubMed PMID Abstract Background: Vancomycin is widely used to treat neonatal late-onset sepsis (LOS). However, its optimal pharmacokinetic/pharmacodynamic targets in neonates, particularly those with very low birth weight (VLBW), remain inadequately defined. Therefore, the objective of this study is to identify vancomycin exposure thresholds associated with early clinical and microbiologic effectiveness in VLBW neonates with LOS. Methods: A multicenter observational study included VLBW neonates who received vancomycin for LOS and had at least 1 steady-state trough concentration measured. Based on clinical and microbiological outcomes within the first 72 hours of vancomycin therapy, patients were categorized into 2 groups: early clinical and microbiological cure (ECMC) and late clinical and microbiological cure. Vancomycin exposure threshold predictive of ECMC was identified using classification and regression tree analysis and the receiver operating characteristic curve. Results: Thirty-six VLBW neonates with confirmed Gram-positive LOS were included, of whom 27 (75%) achieved ECMC. A significant correlation was observed between area under the curve (AUC)24 and trough concentrations (R2 = 0.568; P < 0.001). Both AUC24 and trough concentrations were significantly higher in the ECMC than in the late clinical and microbiological cure group [median (interquartile range), 257 (229-330) vs. 175 (151-223) mg·h/L; P = 0.005; 10.2 (6.0-13.3) vs. 5.1 (3.0-10.0) mg/L; P = 0.043, respectively]. An AUC24/MIC threshold of ≥ 253 mg.h/L was identified as the optimal threshold associated with ECMC with better discriminative performance than trough concentrations (AUC-receiver operating characteristic, 0.813 vs. 0.726; P = 0.005 and P = 0.045, respectively). Conclusions: While both exposure metrics demonstrated good predictive performance for ECMC in VLBW neonates with LOS, an AUC24/MIC ≥253 mg·h/L showed superior discriminative performance compared with trough concentrations. Prospective validation of this exposure threshold in larger cohorts is warranted. Keywords: ELBW; VLBW; clinical outcome; neonates; pharmacokinetic/pharmacodynamic; vancomycin. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. PubMed Disclaimer Conflict of interest statement The authors have no funding or conflicts of interest to disclose. References Vogiantzi G, Metallinou D, Tigka M, et al. Bloodstream infections in the neonatal intensive care unit: a systematic review of the literature. Cureus. 2024;16:e68057. Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, et al. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018;6:223–230. Fleischmann C, Reichert F, Cassini A, et al. Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis. Arch Dis Child. 2021;106:745–752. Hornik CP, Fort P, Clark RH, et al. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Hum Dev. 2012;88(Suppl 2):S69–S74. Fang P, Gao K, Yang J, et al. Prevalence of multidrug-resistant pathogens causing neonatal early and late onset sepsis, a retrospective study from the tertiary referral children’s hospital. Infect Drug Resist. 2023;16:4213–4225. Show all 37 references [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Send To Clipboard Email Save My Bibliography Collections Citation Manager [x] NCBI Literature Resources MeSH PMC Bookshelf Disclaimer The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.
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