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Vancomycin in Oregon: Who's Using It and Why

Published online by Cambridge University Press:  02 January 2015

Paul R. Cieslak ,
Larry J. Strausbaugh ,
David W. Fleming  and
Julia M. Ling
Paul R. Cieslak*
Affiliation:
Division of Applied Public Health Training, State Branch, Preventive Medicine Residency, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Larry J. Strausbaugh
Affiliation:
Veterans' Affairs Medical Center, Portland, Oregon
David W. Fleming
Affiliation:
Oregon Health Division, Portland, Oregon
Julia M. Ling
Affiliation:
Chapter 14 of the Association for Professionals in Infection Control and Epidemiology, Portland, Oregon
*
Oregon Health Division, 800 NE Oregon St, Suite 772, Portland, OR 97232
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 8 , August 1999 , pp. 557 - 560
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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