Evaluation of glycopeptide prescription and therapeutic drug monitoring at a university hospital

Abstract

The aim of this study was to assess the appropriateness of glycopeptide prescription almost 15 y after the publication of the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines. We also assessed the adequacy of dose regimen and therapeutic drug monitoring (TDM). All glycopeptide prescriptions were collected during a 3-month prospective study and evaluated by 2 independent infectious diseases experts. Appropriateness of prescription was assessed according to local guidelines based on the HICPAC recommendations. A total of 154 prescriptions were evaluated: 77% (69.1-83.0) were appropriate and 36% (28.2-43.8) were adequate with regard to dose regimen and loading dose. Multivariate analysis showed greater appropriateness for vancomycin than for teicoplanin (p=0.01). There was a wide discrepancy among units (p=0.04). TDM was appropriately performed in 40% (32.3-47.7) of glycopeptide treatments. When required, dose regimen adaptations occurred in 58% of cases. In conclusion, we show a satisfactory appropriateness of glycopeptide prescription. However, the adequacy of dose regimens must be improved. Finally, TDM does not comply with recent recommendations in most cases.

Inappropriate Continued Empirical Vancomycin Use in a Hospital with a High Prevalence of Methicillin-Resistant Staphylococcus aureus

“…The prevalence of MRSA was lower when the guidelines were developed, but now it is as high as 30 to 50% in many countries (19). Because of the association between delayed administration of adequate antibiotic therapy and poor prognoses for patients with MRSA bacteremia, the empirical use of vancomycin for suspected Gram-positive bacterial infections has been considered adequate by some researchers (10,20). The initial empirical use of antibiotics with activity against all likely pathogens for patients with sepsis, severe sepsis, or septic shock is recommended by the Surviving Sepsis Campaign (21).…”

“…Factors associated with the inappropriate use of vancomycin have been evaluated in several studies (2,10,11,25). However, risk factors for inappropriate continuation of empirical vancomycin treatment are less frequently studied.…”

“…We included only patients who were at least 18 years of age. Two prescriptions for the same patient that were separated by 8 days or more were considered independent uses (10).…”

“…Although the Infectious Diseases Society of America (IDSA) recommends empirical vancomycin use in several circumstances for patients with neutropenia (9), continued empirical use of vancomycin for presumed infections in patients whose culture results are negative for beta-lactam-resistant Gram-positive microorganisms is considered inappropriate. In the guidelines of the CDC and the IDSA, it is strongly recommended that empirical vancomycin treatment be stopped when available culture results fail to reveal beta-lactam-resistant Gram-positive bacterial infections (1,9); however, it is well known that empirical vancomycin use is inappropriately continued for a proportion of patients (2,3,10,11).…”

Utilization Pattern of Vancomycin in a University Teaching Hospital in Oman: Comparison with International Guidelines

“…These recommendations became widely accepted in many hospitals worldwide. Several studies evaluating the pattern of use of vancomycin have been conducted [6][7][8]. However, most of these were conducted in developed countries, and data on the utilization of vancomycin in developing regions remain sparse.…”