Vancomycin Use in a University Medical Center: Comparison With Hospital Infection Control Practices Advisory Committee Guidelines

Abstract

Vancomycin use in our teaching center often was inconsistent with HICPAC guidelines. Information from the audit will be useful for designing strategies to improve vancomycin use.

Vancomycin use in a brazilian teaching hospital: comparison with the Hospital Infection Controlpractices Advisory Committee Guidelines (HICPAC)

“…In a Brazilian tertiary hospital, the empiric treatment was responsible for 81.1% of appropriate vancomycin use (because of hospital epidemiology) and 65.2% was inappropriate [36]. In other studies, the empiric treatment with vancomycin was considered the second largest category of inappropriate use (26%), and in others two studies it was considered the first, with 67% of inappropriate use [8,27,37].…”

“…The empiric use in other studies [8,27,37] varied between 33% and 71%, among all patients that received vancomycin, Success rates in the management of Gram-positive infections (post surgical patients, ventilator-associated pneumonia, peritonitis, bacteremia and meningitis) were enhanced by early therapy with active agents against the organisms later identified by the appropriate culture. Inadequate therapy is closely correlated with adverse patient outcomes, including increased rates of hospital mortality [35,38,39].…”

Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC)

“…Ninety-five patients (72.0%), among all patients, received empiric treatment of suspected Gram-positive infections. In previous studies, the reported empiric use varied between 33% and 71%, among all patients that received vancomycin [12,20,34]. Success rates in the management of Gram-positive infections (post surgical patients, ventilator-associated pneumonia, peritonitis, bacteremia …”

“…The empiric use was responsible for 75.4% of prescriptions considered adequate, because of hospital epidemiology ( Table 1). The empiric treatment with vancomycin was considered the second largest category of inappropriate use (26%), and in others two studies it was considered the first, with 67% of inappropriate use [12,20,34]. For instance, the HICPAC guidelines state that vancomycin is the appropriate treatment for infections caused by Grampositive microorganisms in patients who have serious allergies to beta-lactam antibiotics; we considered "appropriate" the unique case of allergy that was cited in patient's chart, though the allergy severity wasn't specified.…”

“…Several American studies have measured the appropriateness of vancomycin use based on these guidelines, with estimates of appropriate use ranging from 20% to 40%, in absence of restriction policies [20,[33][34][35].…”