Evaluation of vancomycin therapy in the adult ICUs of a teaching hospital in southern Iran

Vazin, Afsaneh; Birjand, Motahareh Mahi; Darake, Masoud

doi:10.2147/dhps.s149451

Cited by 7 publications

(8 citation statements)

References 30 publications

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“…Also, in two other studies conducted in ICUs of Nemazee hospital, it was reported that the rate of Vancomycin and Colistin use, as two commonly used antibiotics in critically ill patients, were in accordance with standard guidelines in 47.3% and 67.3% of the cases, respectively 11,29…”

Section: Discussionmentioning

confidence: 82%

Evaluation of aminoglycosides utilization in intensive care units of a teaching hospital in southern Iran

Vazin¹,

Mirjalili²,

Asadi³

2019

Pharm Pract (Granada)

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Background:Inappropriate use of antimicrobial agents is one of the most important factors in inducing resistance and prolonged hospitalization as well as increase in patient mortality rate.Objective:The aim of this study was to evaluate aminoglycosides (AGs) usage pattern at intensive care units (ICUs) of Nemazee hospital Shiraz, Iran.Methods:In this cross-sectional study, the usage pattern of AGs was evaluated during 32 months. Guidelines for AGs usage were approved by the drug and therapeutic committee of the hospital, and criteria were developed to assess 11 parameters involving AGs therapy, such as proper indication for the use of the drug, dosage and duration of therapy. Clinical parameters, such as microbial culture and sensitivity, serum creatinine (SCr) and creatinine clearance, and white blood cell count were evaluated.Results:Ninety-five patients were recruited, 50 male and 45 females. In most patients (64%) the origin of infection was hospital and only in 36% of them, community was the source. Ventilator associated pneumonia (27%), central nervous system (25%) and urinary tract infection (10%) were the most important indications for AGs prescription. Scores of AGs usage at Nemazee hospital was calculated as 5.9 out of 11, which meant that in only 54% of cases AGs prescription was based on guideline proposed by the Department of Clinical Pharmacy of Nemazee Hospital.Conclusions:Non-adherence to the guidelines occurred frequently in the ICUs of Nemazee hospital. Prescription of loading dose, and AGs level measurement were not done and evaluating microbiological data was often neglected. Incorporating pharmacists in the health care team and holding training programs for physicians and nurses with the goal of raising awareness about the proposed guideline.

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Section: Discussionmentioning

confidence: 82%

Evaluation of aminoglycosides utilization in intensive care units of a teaching hospital in southern Iran

Vazin¹,

Mirjalili²,

Asadi³

2019

Pharm Pract (Granada)

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“…This practice was reported in both adult and paediatric wards, in developed countries such as the United States and developing countries such as Iran. 6,20,21 For instance, Keyserling et al 22 reported that 84% of vancomycin prescription in neonatology wards is empiric. The high empiric use of vancomycin at JUH is alarming.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin audit in the paediatric population: Patterns of use and appropriateness of therapeutic drug monitoring

Jalil

Khaled

Qaryouti

et al. 2023

Basic Clin Pharma Tox

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Aims: This study aims to investigate prescribing and therapeutic drug monitoring (TDM) practices for vancomycin in paediatrics at the Jordan University Hospital and to determine the impact of inaccuracies in TDM data on dosing decisions.Methods: Patterns of vancomycin prescriptions, appropriateness of vancomycin dosing, duration, TDM, and the accuracy of the recorded dosing/sampling times were determined prospectively based on prespecified criteria. Finally, Monte Carlo simulations were undertaken using the mrgsolve-package in R to assess the effect of inaccuracies in recording dosing/sampling times on subsequent dose adjustments.Results: Four hundred forty-two vancomycin courses were analysed. Vancomycin prescriptions were mainly empirical (77.4%). Initial vancomycin doses were appropriate in 73.1% of vancomycin courses. Prolonged use (>5 days) was found in 45.7% of admissions with negative cultures; this was related to the diagnosis of suspected sepsis unadjusted-OR: 1.8 (1.1-2.9). TDM was appropriately ordered in 90.7% of concentrations. Discrepancies between the recorded and actual times were noted in 83.9% and 82.7% of audited times of dose administration and sample collection, respectively. Based on simulations, these discrepancies were predicted to result in inappropriate dose adjustment in 37.9% of patients. Conclusions: Inappropriate empirical and prolonged vancomycin use and inaccuracies in recording dosing/sampling times are important areas of improvement in the current clinical practice.

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“…Vazin et al performed a similar study in Namazee hospital in Shiraz. The information of 95 patients hospitalized in intensive care units was collected, and 47.5% accordance to IDSA was reported based on their results (11).…”

Section: Discussionmentioning

confidence: 99%

Retrospective Drug Utilization Evaluation of Vancomycin Usage in Infectious Wards and Intensive Care Units in Hamedan Teaching Hospitals, April to September 2020

Ghollar

Rangchian

Etminaniesfahani

2021

Avicenna J Pharm Res

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Background: Drug utilization evaluation (DUE) was performed to assess using drugs with special conditions such as antibiotics. Vancomycin is one of the essential antibiotics that is effective on methicillin-resistant Staphylococcus aureus, but unreasonable use of vancomycin, in addition to cost, leads to outbreak microbial resistance, which is a concern for health care systems all around the world. The aim of this study was to evaluate vancomycin use in teaching hospitals in Hamedan, Iran. Methods: This retrospective study was performed on patients who received vancomycin for at least 72 hours in intensive care units and infectious wards between April and September 2020 in the teaching hospitals of Hamedan. Data were obtained from patients’ medical records and entered into predesigned checklists. Results: From 661 patients, 441 were males and 247 were females. They received vancomycin for an average of 5.75 days. The most prevalent indication for vancomycin use was surgery. Only 40 patients had sensitive microbial culture to vancomycin, while 356 of them (53.9%) had no microbial culture at all. According to HICPAC guidelines, the overall appropriate use of vancomycin was 44.8%. Conclusion: According to the results, the irrational use of vancomycin must be corrected to achieve maximum optimal use; thus, performing and adhering to microbial culture, deploying clinical pharmacists, and holding explanatory sessions for health care are recommended for this purpose.

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Evaluation of vancomycin therapy in the adult ICUs of a teaching hospital in southern Iran

Cited by 7 publications

References 30 publications

Evaluation of aminoglycosides utilization in intensive care units of a teaching hospital in southern Iran

Evaluation of aminoglycosides utilization in intensive care units of a teaching hospital in southern Iran

Vancomycin audit in the paediatric population: Patterns of use and appropriateness of therapeutic drug monitoring

Retrospective Drug Utilization Evaluation of Vancomycin Usage in Infectious Wards and Intensive Care Units in Hamedan Teaching Hospitals, April to September 2020

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