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Vancomycin in Oregon: Who's Using It and Why

  • Paul R. Cieslak (a1), Larry J. Strausbaugh (a2), David W. Fleming (a3) and Julia M. Ling (a4)
Abstract
Objective:

To determine the proportion of vancomycin orders that are appropriate according to national guidelines and to identify targets for educational messages.

Design:

Population-based study of vancomycin use in Oregon during a 3-week period. Survey of pharmacists, prospective flagging of vancomycin orders, and data abstraction from patient charts using standardized forms.

Setting:

Nonpsychiatric hospitals in Oregon.

Results:

Four (6%) of the 66 Oregon hospitals had pharmacy restrictions on initial vancomycin orders. Sixty-four (97%) of the hospitals participated in the study of indications for use; 293 vancomycin orders were reported; 3.8 courses were initiated per 1,000 patient-days. Indications for use were determined for 266 (91%); of these, 159 (60%) were deemed appropriate. Of uses for prophylaxis, empirical treatment of suspected gram-positive infection, and treatment of documented gram-positive infection, 57%, 56%, and 65%, respectively, were appropriate. Of hospitals with <250, 251-475, and >475 licensed beds, 65%, 58%, and 57% of vancomycin orders were appropriate. No single medical specialty accounted for >16% of inappropriate vancomycin use.

Conclusions:

Vancomycin was used inappropriately by physicians of many different specialties, in hospitals of all sizes, and in sundry clinical situations. The problem of inappropriate vancomycin use does not lend itself to solution by educational strategies targeted at specific subgroups; restrictions by hospital pharmacies may be required.

Copyright
Corresponding author
Oregon Health Division, 800 NE Oregon St, Suite 772, Portland, OR 97232
References
Hide All
1.Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597599.
2.Spera, RV Jr, Farber, BE. Multidrug-resistant Enterococcus faecium—an untreatable nosocomial pathogen. Drugs 1994;48:678688.
3.Noble, WC, Virani, Z, Cree, RGA. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett 1992;93:195198.
4.Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44(RR-12):113.
5.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.
6.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.
7.Johnson, SV, Hoey, LL, Vancy-Bryan, K. Inappropriate vancomycin prescribing based on criteria from the Centers for Disease Control and Prevention. Pharmacotherapy 1995;15:579585.
8.Morgan, AS, Brennan, PJ, Fishman, NO. Impact of a vancomycin restriction policy on use and cost of vancomycin and incidence of vancomycin-resistant Enterococcus. Ann Pharmacother 1997;31:970973.
9.Logsdon, BA, Lee, KR, Luedtke, G, Barrett, FF. Evaluation of vancomycin in a pediatric teaching hospital based on CDC criteria. Infect Control Hosp Epidemiol 1997;18:780782.
10.Ena, J, Dick, RW, Jones, RN, Wenzel, RP. The epidemiology of intravenous vancomycin usage in a university hospital. JAMA 1993;269:598602.
11.Woodward, RS, Medoff, G, Smith, MD, Gray, JL. Antimicrobial cost savings from formulary restrictions and physician monitoring in a medical-school-affiliated hospital. Am J Med 1987;83:817823.
12.McGowan, JE Jr, Finland, M. Usage of antibiotics in a general hospital: effect of requiring justification. J Infect Dis 1974;130:165168.
13.Anglim, AM, Klym, B, Byers, KE, Scheld, WM, Farr, BM. Effect of a vancomycin restriction policy on ordering practices during an outbreak of vancomycin-resistant Enterococcus faecium. Arch Intern Med 1997;157:11321136.
14.Pestotnik, SL, Classen, DC, Evans, RS, Burke, JP. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996;124:884890.
15.Singer, MV, Haft, R, Barlam, 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.
16.Jarvis, WR. Preventing the emergence of multidrug-resistant microorganisms through antimicrobial use controls: the complexity of the problem. Infect Control Hosp Epidemiol 1996;17:490495.
17.Duncan, RA. Controlling use of antimicrobial agents. Infect Control Hosp Epidemiol 1997;18:260266.
18.John, JF Jr, Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471485.
19.Goldmann, DA, Weinstein, RA, Wenzel, RP, Tablan, OC, Duma, RJ, Gaynes, RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals: a challenge to hospital leadership. JAMA 1996;275:234240.
20.Centers for Disease Control and Prevention. Reduced susceptibility of Staphylococcus aureus to vancomycin—Japan, 1996. MMWR 1997;46:624626.
21.Centers for Disease Control and Prevention. Staphylococcus aureus with reduced susceptibility to vancomycin—US. MMWR 1997;46:765766.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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