Abstract
BackgroundVancomycin use is considered inappropriate in most hospitals. A particular concern is the recent emergence of S. aureus with decreased susceptibility to vancomycin, making it important to reduce overall exposure to vancomycin to minimize the incidence of VRE (vancomycin-resistant enterococci). The aim of this work was to analyze the use of vancomycin and the risk factors associated with inappropriate treatment.MethodsA prospective survey was conducted on all patients receiving vancomycin between 1st March 2002 and 30th September 2002 in a university-school hospital. Appropriateness of vancomycin use was assessed, according to the criteria established by the Centers for Disease Control and Prevention (CDC), at two time points: first, at the beginning of therapy, and second, continuing after 72 hours.ResultsA total of 557 patients received vancomycin. Three hundred seventy-four (67.1%) were under 60 years old, 374 (67.1%) had prolonged stays (>two weeks) in hospital, and 455 (81.7%) were in the intensive care unit (ICU). Two hundred sixty-three patients (47.2%) had some invasive device. In 324 (58.2%) patients the duration of vancomycin treatment was up to two weeks. Vancomycin was inappropriately used in 65.7% during the first 24 hours and in 67% at the 72 hours point according to CDC criteria [4]. The inappropriateness of vancomycin use during the first 24 hours was related to: patients aged less than 60 (OR 1.7; CI 95% 1.1–2.5), non-ICU patients (OR 1.5; CI 95% 1.0–2.4) and patients without neutropenia (OR 7.5; CI 95% 2.4–22.7). At 72 hours, the inappropriateness of vancomycin use was related to: patients aged less than 60 (OR 1.5; CI 95% 1.0–2.3), non-ICU patients (OR 1.7; CI 95% 1.1–2.7) and patients without neutropenia (OR 8.0; CI 95% 2.6–24.3).ConclusionVancomycin was abused. Patients aged less than 60, non-ICU patients and those who did not present neutropenia were the principal groups at risk of inappropriate use.
Highlights
Vancomycin use is considered inappropriate in most hospitals
Univariate analysis showed that the risk factors associated with inappropriate vancomycin use at the two time points, according to the Centers for Disease Control and Prevention (CDC) criteria, were patients under 60 years old, those who were hospitalized in units other than intensive care unit (ICU), and those without central venous catheters or with a central venous catheter for no longer than two weeks
When the two time periods were examined by multivariate analysis, inappropriate vancomycin use was found to be in patients under 60 years old, without neutropenia and outside ICUs (Table 6)
Summary
Setting The study was carried out in the Federal University of Sao Paulo a teaching hospital between March and September 2002 It had previously been approved by the Ethics in Research Committee. As vancomycin is a restricted-use antibiotic in the hospital, prescription depended upon evaluation by the Antimicrobial Rationalization Service. This department evaluates all requests for restricted-use antimicrobials according to completed requirement forms. The indication was assessed at the first 24 hours and after 72 hours, according to the CDC criteria [4] These criteria are described, which relates to vancomycin treatment of patients with (1) infections caused by βlactam-resistant Gram-positive microorganisms, (2) allergies to this same class of antibiotics or (3) failure to respond to metronidazole therapy for pseudomembranous colitis. Statistical analyses were performed using SAS software version 8.0 (Statistical Analysis System, Cary, NC, USA)
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