Appropriate Use of Vancomycin in NICU Despite Free-for-All Policy

Abstract

OBJECTIVES: Because of increases in antimicrobial resistance, the use of vancomycin in late-onset sepsis has come under scrutiny. The primary outcome of this study was to determine if vancomycin for the treatment of late-onset sepsis in the neonatal intensive care unit (NICU) was being discontinued within 72 hours according to the existing protocol. Secondary outcomes included the appropriateness of therapeutic drug monitoring associated with vancomycin, and renal dysfunction associated with the use of vancomycin in the NICU outside of the 72-hour policy. METHODS: A retrospective chart review was completed for patients in the NICU who received vancomycin for the treatment of late-onset sepsis between the dates of January 1, 2014, and July 1, 2014. RESULTS: There were 125 vancomycin treatment courses, of which 97 were included. Appropriate use of vancomycin, per policy, occurred in a total of 87 of 97 courses (89.6%). Therapeutic drug monitoring was evaluated by the number of appropriate troughs, determined using renal function and previous trough concentrations. There was not a statistically significant difference in the number of inappropriate troughs drawn between those that were continued on vancomycin appropriately (n = 17 courses; 4 of 44 inappropriate troughs) versus inappropriately (n = 10 courses; 1 of 22 inappropriate troughs; p = 0.66), despite the large number of troughs drawn. Adverse renal outcomes were not statistically significant in patients continued inappropriately on vancomycin (p = 1.0). CONCLUSIONS: Vancomycin use in the NICU for late-onset sepsis is appropriate per the existing antibiotic policy. Therapeutic drug monitoring could be improved, and adverse renal outcomes due to inappropriate continuation of vancomycin are rare.

Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

“…However, prescribing the right dose and dosing regimen remains a challenge in neonatal intensive care units . The high degree of pharmacokinetic variability in neonates makes TDM essential to ensure adequate therapeutic exposure and prevent adverse renal outcomes …”

“…52 The high degree of pharmacokinetic variability in neonates makes TDM essential to ensure adequate therapeutic exposure 53 and prevent adverse renal outcomes. 54 When using TDM in neonates the basic rules apply. However, additional factors should also be taken into consideration.…”

Vancomycin-lock therapy for prevention of catheter-related bloodstream infection in very low body weight infants

“…The Gram-positive coccus are the major types of pathogens in bacteria biofilms [ 26 , 27 ]. Vancomycin has an inhibitory effect on a variety of gram-positive cocci, particularly bacteria in the inner catheter bacteria biofilm [ 28 , 29 ], and its efficacy and safety in neonates has been confirmed [ 30 , 31 ]. Therefore, vancomycin was selected for antibiotic-lock so as to prevent the incidence of CRBSI, which is consistent with some reports using vancomycin as the main locking antibiotic [ 23 , 32 , 33 ].…”

Vancomycin-lock therapy for prevention of catheter-related bloodstream infection in very low body weight infants

“…The Gram-positive coccus are the major types of pathogens in bacteria bio lms [26,27]. Vancomycin has an inhibitory effect on a variety of gram-positive cocci, particularly bacteria in the inner catheter bacteria bio lm [28,29], and its e cacy and safety in neonates has been con rmed [30,31]. Therefore, vancomycin was selected for antibioticlock so as to prevent the incidence of CRBSI, which is consistent with some reports using vancomycin as the main locking antibiotic [32][33][34].…”