Background: Vancomycin therapeutic drug monitoring (TDM) has traditionally relied on trough concentrations; however, recent guidelines recommend area under the curve (AUC)-based monitoring due to its potential to improve efficacy and safety. Limited studies have evaluated the impact of AUC-based dosing on clinical outcomes, particularly in South Korea. Methods: This single-center retrospective cohort study compared the incidence of acute kidney injury (AKI) and total vancomycin usage between patients receiving TDM based on AUC versus trough concentrations. Propensity score matching was applied to balance baseline characteristics, including age, sex, body weight, renal function, and concomitant nephrotoxic medication use. The study analyzed data from adult patients with normal renal function treated between 2021 and 2023. Results: After propensity score matching, AKI incidence was significantly lower in the AUC-based group (1.20%) compared to the trough-based group (5.08%) (odds ratio 0.23, 95% CI: 0.09–0.59, p = 0.0021). Although no significant differences were observed in treatment duration or dose adjustments, the total administered vancomycin dose was significantly reduced in the AUC-based group. This reduction likely contributed to lower AKI rates and decreased unnecessary drug exposure. Conclusions: Compared to trough-based dosing, AUC-based vancomycin dosing significantly reduced AKI incidence and total drug usage in adult patients with normal renal function. These findings underscore the importance of adopting AUC-based TDM in clinical practice to enhance patient safety and optimize vancomycin therapy. Further studies are needed to evaluate the broader implementation of AUC-based monitoring in diverse clinical settings.

Background: Kawasaki disease (KD) is an acute type of vasculitis in children, with coronary artery aneurysm (CAA) being its most serious complication. Intravenous immunoglobulin (IVIg) with acetylsalicylic acid (ASA) is the standard treatment, but concerns about IVIg’s availability and adverse effects have led to interest in corticosteroids (CSs) as an alternative. This study compares the clinical outcomes of IVIg and CSs in KD patients. Methods: Using South Korean Health Insurance Review and Assessment Service (HIRA) data from 2017 and 2020, we identified children under five diagnosed with KD and treated with IVIg and ASA (the IVIg group) or CSs and ASA (the CS group). Propensity score weighting was applied. The primary outcome was the incidence of CAA, and the secondary outcome included cardiovascular complications. Cox proportional hazards models were used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs). Results: After adjustment, the CAA incidence was higher in the CS group (6.72%) than in the IVIg group (1.86%) (HR = 3.70; 95% CI: 1.96–6.97; p < 0.0001). Cardiovascular complications were also more frequent in the CS group (HR = 2.87; 95% CI: 1.96–6.97; p < 0.0001). Conclusions: The combination treatment, of CSs and ASA, was associated with a higher risk of CAA and cardiovascular complications compared to that when using IVIg in pediatric KD patients. While CSs may be beneficial as an adjunct therapy in IVIg-resistant cases, they should not replace IVIg as a first-line treatment. Alternative strategies, such as reduced-dose IVIg with adjunctive therapies, should be explored.

Background: Foodborne illness surveillance commonly focuses on reported outbreaks and laboratory-confirmed infections. Nationwide information on foodborne illness-related diagnoses recorded during routine healthcare encounters remains limited in South Korea. This study described the volume and distribution of claims-defined foodborne illness-related episodes and associated diagnostic category records documented in the 2023 HIRA database. Methods: This nationwide retrospective descriptive study used administrative reimbursement claims data from the Health Insurance Review and Assessment Service in 2023. Repeated qualifying encounters for the same patient were grouped into episodes using a 30-day gap rule. For the monthly analysis, each episode was counted once and assigned to the diagnostic category first recorded during the episode; other category-specific analyses used non-mutually exclusive diagnostic category records. Unique episodes were summarized by calendar month, whereas diagnostic category records were summarized by demographic characteristics, selected underlying diseases, healthcare institution type, and region. Results: A total of 6,829,577 unique claims-defined episodes generated 7,754,215 diagnostic category records because an episode could contribute to more than one diagnostic category. Unspecified records accounted for 79.3%, followed by bacterial records (12.1%), viral records (8.6%), and protozoal/other-cause records (<0.1%). Viral and unspecified records were more frequently observed in younger age groups, whereas bacterial records were concentrated among adults aged 19–64 years. Most records were associated with clinic visits (80.3%). Monthly episode counts showed variation, with the highest count observed in July and relatively high counts also observed in January, August, and September. Crude record rates based on healthcare institution location varied across regions. Conclusions: Foodborne illness-related diagnostic records were predominantly unspecified and were most frequently documented in clinics, suggesting limited etiologic specificity in routine diagnostic coding. Claims-based findings may complement existing surveillance but should not be interpreted as confirmed disease incidence or etiologic distribution.