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Background  Pharmacokinetic-pharmacodynamic (PK/PD) targets of vancomycin therapy have been recognized for methicillin-resistant  Staphylococcus aureus  infections but not for other gram-positive bacterial infections. Therefore, we investigated whether vancomycin concentration targets such as the trough level and ratio of the area under the curve to minimum inhibitory concentration (AUC/MIC) are associated with the treatment outcome in enterococcal bacteremia.    Methods  A retrospective cohort analysis enrolled patients with bacteremia caused by vancomycin-susceptible  Enterococcus faecium  and  Enterococcus faecalis  who were treated with vancomycin from January 2007 to December 2017 at a tertiary hospital located in Seoul, South Korea. Patients without vancomycin concentrations were excluded from the study. The primary outcome was 28-day all-cause mortality.    Results  A total of 37 patients were enrolled—26 with  E .  faecium  infection and 11 with  E .  faecalis  infection. The 28-day all-cause mortality rate was 21.6 %. In univariate analysis, vancomycin trough level (≤ 15 µg/mL;  p  = 0.042), age ( p  = 0.044), and septic shock ( p  = 0.049) were associated with 28-day mortality but not AUC24/MIC (> 389;  p  = 0.479). In multivariate analysis, vancomycin trough concentration (≤ 15 µg/mL;  p  = 0.041) and younger age ( p  = 0.031) were associated with 28-day mortality in patients with enterococcal bacteremia.    Conclusions  In this study, a vancomycin trough level of 15 µg/mL or lower was associated with 28-day mortality in enterococcal bacteremia. However, relatively large prospective studies are needed to examine the efficacy of vancomycin PK/PD parameters in patients with enterococcal bacteremia.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12879-021-06809-x.

Association of vancomycin trough concentration on the treatment outcome of patients with bacteremia caused by Enterococcus species