Analysis of vancomycin use and associated risk factors in a university teaching hospital: a prospective cohort study

Moacyr S Junior, Luci Correa, Alexandre R Marra, Luis F A Camargo, Carlos A P Pereira, Moacyr S Junior, Luci Correa, Alexandre R Marra, Luis F A Camargo, Carlos A P Pereira

Abstract

Background: Vancomycin 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.

Methods: A 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.

Results: A 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).

Conclusion: Vancomycin 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.

References

    1. Goldmann DA, Huskin WC. Control of nosocomial antimicrobial-resistant bacteria: A strategic priority for hospitals worldwide. Clin Infect Dis. 1997;24:S139–45.
    1. Ena J, Dick RW, Jones RN, Wenzel RP. The epidemiology of intravenous vancomycin usage in a university hospital. A 10-year study. JAMA. 1993;269:598–602. doi: 10.1001/jama.269.5.598.
    1. Mayhall CG. Prevention and control of vancomycin resistance in Gram positive coccal microorganisms: Fire prevention and fire fighting. Infect Control Hosp Epidemiol. 1996;17:353–355.
    1. CDC-Centers for Disease Control and Prevention Recommendations for preventing spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC) MMWR. 1995;44:1–12.
    1. Evans ME, Kortas KJ. Vancomycin use in a university medical center: comparison with hospital infection control practices advisory committee guidelines. Infect Control Hosp Epidemiol. 1996;17:356–359.
    1. Cieslak PR, Strausbaugh LJ, Flemming DW, Ling JM. Vancomycin in Oregon: Who's using it and why. Infect Control Hosp Epidemiol. 1999;20:557–560. doi: 10.1086/501669.
    1. McCabe WR, Jackson CG. Gram negative bacteremia II: clinical, laboratory, and therapeutic observations. Arch Intern Med. 1962;110:856–864.
    1. Charlson ME, Sax FL, Mackenzie CR, Fields SD, Braham RL, Douglas RG. Assessing illness severity: does clinical judgment work? J Chronic Dis. 1986;39:439–452. doi: 10.1016/0021-9681(86)90111-6.
    1. Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother. 1997;40:135–136. doi: 10.1093/jac/40.1.135.
    1. Lautenbach E, Bilker WB, Brennan PJ. Enterococcal bacteremia: Risk factors for vancomycin resistance and predictors of mortality. Infect Control Hosp Epidemiol. 1999;20:318–323. doi: 10.1086/501624.
    1. Fridkin SK. Vancomycin-intermediate and resistant Staphylococcus aureus: What the infectious disease specialist needs to know. Clin Infect Dis. 2002;32:108–115. doi: 10.1086/317542.
    1. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM. SHEA Guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol. 2003;24:362–386. doi: 10.1086/502213.
    1. Conterno LO, Wey SB, Castelo A. Risk factors for mortality in Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol. 1998;19:32–37.
    1. Logsdon BA, Lee KR, Luedtkeg G, Barrett FF. Evaluation of vancomycin use in a pediatric teaching hospital based on CDC criteria. Infect Control Hosp Epidemiol. 1997;18:780–782.
    1. Hamilton CD, Drew R, Janning SW, Latour JK, Hayward S. Excessive use of vancomycin: A successful intervention strategy at an academic medical center. Infect Control Hosp Epidemiol. 2000;21:42–45. doi: 10.1086/501703.
    1. Wright SW, Wrenn KD. Appropriateness of vancomycin use in the emergency department. Ann Emerg Med. 1998;32:531–536. doi: 10.1016/S0196-0644(98)70030-7.
    1. Green K, Schulman G, Haas DW, Schaffner W, D'Agata EM. Vancomycin prescribing practices in hospitalized chronic hemodialysis patients. Am J Kidney Dis. 2000;35:64–68.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit