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Evaluating Vancomycin Use at a Pediatric Hospital: New Approaches and Insights

  • Maureen K. Bolon (a1) (a2) (a3), Alana D. Arnold (a4), Henry A. Feldman (a5), David H. Rehkopf (a6), Emily F. Strong (a7), Donald A. Goldmann (a1) and Sharon B. Wright (a1)...



To characterize vancomycin use at a pediatric tertiary-care hospital, to discriminate between initial (≤ 72 hours) and prolonged (> 72 hours) inappropriate use, and to define patient characteristics associated with inappropriate use.


Vancomycin courses were retrospectively reviewed using an algorithm modeled on HICPAC guidelines. Data were collected regarding patient demographics, comorbidities, other medication use, and nosocomial infections. The association between each variable and the outcome of inappropriate use was determined by longitudinal regression analysis. A multi-variable model was constructed to assess risk factors for inappropriate initial and prolonged vancomycin use.


A pediatric tertiary-care medical center.


Children older than 1 year who received intravenous vancomycin from November 2000 to June 2001.


Three hundred twenty-seven vancomycin courses administered to 260 patients were evaluated for appropriateness. Of initial courses, 114 (35%) were considered inappropriate. Of 143 prolonged courses, 103 (72%) were considered inappropriate. Multivariable risk factor analysis identified the following variables as significantly associated with inappropriate initial use: admission to the surgery service, having a malignancy, receipt of a stem cell transplant, and having received a prior inappropriate course of vancomycin. No variables were identified as significant risk factors for inappropriate prolonged use.


Substantial inappropriate use of vancomycin was identified. Prolonged inappropriate use was a particular problem. This risk factor analysis suggests that interventions targeting patients admitted to certain services or receiving multiple courses of vancomycin could reduce inappropriate use.


Corresponding author

Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 200, Chicago, IL


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1.Tenover, FC, Biddle, JW, Lancaster, MV. Increasing resistance to vancomycin and other glycopeptides in Staphylococcus aureus. Emerg Infect Dis 2001;7:327332.
2.Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). Am J Infect Control 1995;23:8794.
3.Drinkovic, D, Taylor, SL, Pottumarthy, S, Morris, AJ. Prospective vancomycin audit in Auckland healthcare hospitals. N Z Med J 1999;112:336339.
4.You, JH, Lyon, DJ, Lee, BS, Kwan, SM, Tang, HY. Vancomycin utilization at a teaching hospital in Hong Kong. Am J Health Syst Pharm 2001;58:21672169.
5.Beidas, S, Khamesian, M. Vancomycin use in a university medical center: comparison with Hospital Infection Control Practices Advisory Committee guidelines. Infect Control Hosp Epidemiol 1996;17:773774.
6.Watanakunakorn, C. Prescribing pattern of vancomycin in a community teaching hospital with low prevalence of vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1997;18:767769.
7.Cieslak, PR, Strausbaugh, LJ, Fleming, DW, Ling, JM. Vancomycin in Oregon: whO's using it and why. Infect Control Hosp Epidemiol 1999;20:557560.
8.Green, K, Schulman, G, Haas, DW, Schaffner, W, D'Agata, EM. Vancomycin prescribing practices in hospitalized chronic hemodialysis patients. Am J Kidney Dis 2000;35:6468.
9.Johnson, SV, Hoey, LL, Vance-Bryan, K. Inappropriate vancomycin prescribing based on criteria from the Centers for Disease Control and Prevention. Pharmacotherapy 1995;15:579585.
10.Roghmann, MC, Perdue, BE, Polish, L. Vancomycin use in a hospital with vancomycin restriction. Infect Control Hosp Epidemiol 1999;20:6063.
11.Singer, MV, Haft, R, Bariam, T, Aronson, M, Shafer, A, Sands, KE. Vancomycin control measures at a tertiary-care hospital: impact of interventions on volume and patterns of use. Infect Control Hosp Epidemiol 1998;19:248253.
12.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;17:356359.
13.Shah, SS, Sinkowitz-Cochran, RL, Keyserling, HL, Jarvis, WR. Vancomycin use in pediatric neurosurgery patients. Am J Infect Control 1999;27:482487.
14.Kahyaoglu, O, Akpinar, M, Nolan, B, Inoue, S, Zureikat, G, Kumar, A. Vancomycin use and monitoring in pediatric patients in a community hospital. Infect Control Hosp Epidemiol 1998;19:299, 301.
15.Hopkins, HA, Sinkowitz-Cochran, RL, Rudin, BA, Keyserling, HL, Jarvis, WR. Vancomycin use in pediatric hematology-oncology patients. Infect Control Hosp Epidemiol 2000;21:4850.
16.Logsdon, BA, Lee, KR, Luedtke, G, Barrett, FF. Evaluation of vancomycin use in a pediatric teaching hospital based on CDC criteria. Infect Control Hosp Epidemiol 1997;18:780782.
17.Ena, J, Dick, RW, Jones, RN, Wenzel, RP. The epidemiology of intravenous vancomycin usage in a university hospital: a 10-year study. JAMA 1993;269:598602.
18.Nourse, C, Byrne, C, Leonard, L, Butler, KGlycopeptide prescribing in a tertiary referral paediatric hospital and applicability of Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines to children. Eur J Pediatr 2000;159:193197.
19.Salemi, C, Becker, L, Morrissey, R, Warmington, J. A clinical decision process model for evaluating vancomycin use with modified HICPAC -guidelines;. Hospital Infection Control Practice Advisery Committee. Clin Perform Qual Health Care 1998;6:1216.
20.Feldman, HA. Families of lines: random effects in linear regression analysis. J Appi Physiol 1988;64:17211732.
21.Diggle, P, Liang, K-Y, Zeger, SL. Analysis of Longitudinal Data: Oxford Statistical Science Series. Oxford: Oxford University Press; 1994:xi, 253.
22.Durmaz, G, Us, T, Aydinli, A, Kiremitci, A, Kiraz, N, Akgun, Y. Optimum detection times for bacteria and yeast species with the BACTEC 9120 aerobic blood culture system: evaluation for a 5-year period in a Turkish university hospital. J Clin Microbiol 2003;41:819821.
23.Nucci, M, Landau, M, Silveira, F, Spector, N, Pulcheri, W. Application of the IDSA guidelines for the use of antimicrobial agents in neutropenic patients: impact on reducing the use of glycopeptides. Infect Control Hosp Epidemiol 2001;22:651653.
24.Paganini, H, Staffolani, V, Zubizarreta, P, Casimir, L, Lopardo, H, Luppino, V. Viridans streptococci bacteraemia in children with fever and neutropenia: a case-control study of predisposing factors. Eur J Cancer 2003;39:12841289.
25.Kesler, RW, Guhlow, LJ, Saulsbury, FT. Prophylactic antibiotics in pediatric surgery. Pediatrics 1982;69:13.
26.Kwan, T, Lin, F, Ngai, B, Loeb, M. Vancomycin use in 2 Ontario tertiary care hospitals: a survey. Clin Invest Med 1999;22:256264.


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