Determination of vancomycin blood concentration and its relationship with safety in patients with orthopedic infection by ultra-performance liquid chromatography-tandem mass spectrometry

• First large-sample application of UPLC-MS/MS for vancomycin therapeutic drug monitoring in orthopedic infection patients, with superior methodological performance compared to traditional immunoassays. • Identified the optimal therapeutic range of vancomycin (10-20 μg/mL) for orthopedic infection patients, providing evidence-based guidance for individualized dosing. • Demonstrated that vancomycin trough concentrations >20 μg/mL significantly increase the incidence of renal impairment, emphasizing the importance of therapeutic drug monitoring in ensuring medication safety. • Explored the potential impact of organic cation transporter 2 and multidrug resistance gene 1 polymorphisms on vancomycin pharmacokinetics, offering new insights for precision medicine.