Inappropriate Continued Use of Empirical Vancomycin in a Hospital with a High Prevalence of MRSA.
Antimicrob Agents Chemother. 2014 Nov 17;
Authors: Kim NH, Koo HL, Choe PG, Cheon S, Kim MS, Lee MJ, Jung YH, Park WB, Song KH, Kim ES, Bang JH, Kim HB, Park SW, Kim NJ, Oh MD, Kim EC
BACKGROUND: Vancomycin is frequently inappropriately prescribed, especially as empirical treatment. The aim of this study was to evaluate (1) the amount of inappropriate continued use of empirical vancomycin as a proportion of total vancomycin use, and (2) the risk factors associated with inappropriate continued use of empirical vancomycin.
METHODS: We reviewed the medical records of adult patients who had been prescribed at least one dose of parenteral vancomycin between January and June 2012 in a single tertiary hospital. When empirically prescribed vancomycin was continued after 96 hours without documentation of beta-lactam-resistant gram-positive microorganisms in clinical specimens with significance, the continuation was considered inappropriate, and the amount used thereafter was considered inappropriately used. We identified risk factors associated with the inappropriate continued use of empirical vancomycin by multiple logistic regression.
RESULTS: During the study period, the amount of parenteral vancomycin prescribed was 34.2 defined daily doses (DDDs)/1,000 patient-days (1,084 prescriptions in 971 patients). The amount of inappropriately continued empirical vancomycin was 8.5 DDDs/1,000 patient-days which comprised 24.9% (8.5/34.2 DDDs/1,000 patient-days) of the total parenteral vancomycin used. By multivariate analyses, inappropriate continued use of empirical vancomycin was independently associated with the absence of any documented etiologic organism (adjusted hazard ratio [aHR] 1.60, 95% confidence interval [CI] 1.06∼2.41), and suspected CNS infection (aHR 2.33, 95% CI 1.20∼4.50). A higher Charlson's comorbidity index score was inversely associated with inappropriate continued use of empirical vancomycin (aHR 0.90, 95% CI 0.85∼0.97).
CONCLUSIONS: Inappropriate continued use of empirical vancomycin comprised 24.9% of the total amount of vancomycin prescribed, this means room for improvement.
PMID: 25403664 [PubMed - as supplied by publisher]