Infection Control & Hospital Epidemiology Our study has several limitations. Although the study institu-
tion performs vancomycin TDM twice weekly, the ideal fre- quency is unclear. We were unable to collect exposure days data automatically, and the process was labor intensive. The cur- rent study included days with subtherapeutic levels of vancomy- cin in the total exposure days due to the impossibility of assessing the period of subtherapeutic exposure via twice weekly TDM. Eliminating these days from the calculation may improve accuracy. In conclusion, vancomycin exposure was ∼10% lower when
assessed using DOT than when using TDM-based exposure days. However, depending on the patient population and density of vancomycin use, additional benchmarks including TDM-based exposure days may be important for calculating the days of vanco- mycin exposure accurately.
Author ORCIDs. Shutaro Murakami, 0000-0003-0261-3874
Acknowledgments. We thank the TDM staff of the Department of Pharmacy at Tokyo Metropolitan Tama Medical Center for their assistance. We are indebted to James R. Valera for his assistance editing the manuscript.
Financial support. No financial support was provided relevant to this article.
377
Conflicts of interest. All the authors report no conflicts of interest relevant to this article.
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