Abstract
BackgroundRecommendations to prevent the spread of vancomycin resistance have been in place since 1995 and include guidelines for inpatient pediatric use of vancomycin. The emergence of large databases allows us to describe variation in pediatric vancomycin across hospitals. We analyzed a database with hospitalizations for children under 18 at 421 hospitals in 2008.Methodology/Principal FindingsThe Premier hospital 2008 database, consisting of records for 877,201 pediatric hospitalizations in 421 hospitals, was analyzed. Stratified analyses and logistic mixed effects models were used to calculate the probability of vancomycin use while considering random effects of hospital variation, hospital fixed effects and patient effects, and the hierarchical structure of the data. Most hospitals (221) had fewer than 10 hospitalizations with vancomycin use in the study period, and 47 hospitals reported no vancomycin use in 17,271 pediatric hospitalizations. At the other end of the continuum, 21 hospitals (5.6% of hospitals) each had over 200 hospitalizations with vancomycin use, and together, accounted for more than 50% of the pediatric hospitalizations with vancomycin use. The mixed effects modeling showed hospital variation in the probability of vancomycin use that was statistically significant after controlling for teaching status, urban or rural location, size, region of the country, patient ethnic group, payor status, and APR-mortality and severity codes.Conclusions/SignificanceThe number and percentage of pediatric hospitalizations with vancomycin use varied greatly across hospitals and was not explained by hospital or patient characteristics in our logistic models. Public health efforts to reduce vancomycin use should be intensified at hospitals with highest use.
Highlights
Vancomycin is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant staphylococci
The greatest number of hospitalizations with vancomycin use occurred to children under 2 (10,282 or 52% of hospitalizations), the highest prevalence of use occurred in children age 2–4, and 5–11 (Figure 1)
At the other end of the continuum, 21 hospitals (5.6% of hospitals) each had over 200 hospitalizations with vancomycin use, and together, accounted for more than 50% of the pediatric hospitalizations with vancomycin use
Summary
Vancomycin is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (beta-lactam-resistant) staphylococci. Patel and colleagues studied the medical records of 200 neonates born after Septermber 2005 at 4 tertiary care (NICUs) and concluded that 32% of the days of vancomycin use were inappropriate and non-adherent to the Centers for Disease Control and Prevention 12 Step Campaign to Prevent Antimicrobial Resistance [3,12]. They noted non-adherence to steps 4 (Target the pathogen) and 8 (Treat infection, not contamination or colonization). We analyzed a database with hospitalizations for children under 18 at 421 hospitals in 2008
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