A Multicenter, Retrospective Outcome Analysis of Vancomycin Area Under the Curve Versus Trough-Based Dosing Strategies in Patients With Burn OR Inhalational Injuries (MONITOR).

This article presents a multicenter, retrospective study comparing area under the curve (AUC)-based versus trough-based vancomycin dosing strategies in adult patients with thermal or inhalational burn injuries. Conducted across 13 burn centers with 485 patients and 517 vancomycin courses, the study found no significant difference in clinical success—defined by infection resolution, relapse, antibiotic failure, acute kidney injury (AKI), and mortality—between the two monitoring methods. Although the trough-based group showed a higher incidence of AKI, this was not statistically significant after adjusting for baseline renal function, chronic kidney disease history, and concomitant nephrotoxic medications. The findings suggest that factors such as patient comorbidities and nephrotoxin exposure may be more critical than monitoring strategy in optimizing vancomycin therapy for burn patients, highlighting the need for further research on appropriate therapeutic targets in this population.