Timing of vancomycin initiation and mortality in critically Ill patients with sepsis and type 2 diabetes: A clone–censor–weighting analysis

Timing of vancomycin initiation and mortality in critically Ill patients with sepsis and type 2 diabetes: A clone–censor–weighting analysis. Timing of vancomycin initiation and mortality in critically Ill patients with sepsis and type 2 diabetes: A clone–censor–weighting analysis Article Open access Published: 31 October 2026 Cite this article You have full access to this open access article Download PDF View saved research Timing of vancomycin initiation and mortality in critically Ill patients with sepsis and type 2 diabetes: A clone–censor–weighting analysis Download PDF Abstract Sepsis in patients with type 2 diabetes mellitus (T2DM) is associated with high mortality. While early antibiotics are crucial, the optimal timing for initiating Gram-positive coverage with vancomycin remains uncertain in this high-risk population.

Observational analyses of treatment timing are susceptible to immortal time and time-dependent confounding. We therefore aimed to evaluate the associations between vancomycin initiation timing and mortality and ICU length of stay among critically ill patients with sepsis and T2DM who ultimately received vancomycin. We conducted a retrospective cohort analysis using data from the MIMIC-IV database, including ICU patients with sepsis and T2DM who received systemic intravenous vancomycin during the index ICU stay.

A cloning–censoring–weighting (CCW) framework was applied within this treated cohort to compare initiation at < 48 h versus ≥ 48 h after ICU admission, with exploratory analyses across four 12-h initiation windows. The primary endpoint was in-hospital mortality; secondary endpoints were 7-, 30-, and 90-day mortality and ICU length of stay. Sensitivity analyses evaluated alternative confounding, weighting, timing-cutoff, and missing-data specifications.

Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with qualified healthcare professionals for medical decisions and treatment options.