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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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References

1.Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
2.Spera, RV Jr, Farber, BE. Multidrug-resistant Enterococcus faecium—an untreatable nosocomial pathogen. Drugs 1994;48:678–688.CrossRefGoogle ScholarPubMed
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;93:195–198.Google Scholar
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):1–13.Google Scholar
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;17:356–359.Google Scholar
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;17:773–774.CrossRefGoogle Scholar
7.Johnson, SV, Hoey, LL, Vancy-Bryan, K. Inappropriate vancomycin prescribing based on criteria from the Centers for Disease Control and Prevention. Pharmacotherapy 1995;15:579–585.Google Scholar
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;31:970–973.Google Scholar
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;18:780–782.Google Scholar
10.Ena, J, Dick, RW, Jones, RN, Wenzel, RP. The epidemiology of intravenous vancomycin usage in a university hospital. JAMA 1993;269:598–602.CrossRefGoogle ScholarPubMed
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;83:817–823.CrossRefGoogle Scholar
12.McGowan, JE Jr, Finland, M. Usage of antibiotics in a general hospital: effect of requiring justification. J Infect Dis 1974;130:165–168.CrossRefGoogle Scholar
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;157:1132–1136.Google Scholar
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;124:884–890.CrossRefGoogle ScholarPubMed
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;19:248–253.CrossRefGoogle Scholar
16.Jarvis, WR. Preventing the emergence of multidrug-resistant microorganisms through antimicrobial use controls: the complexity of the problem. Infect Control Hosp Epidemiol 1996;17:490–495.CrossRefGoogle ScholarPubMed
17.Duncan, RA. Controlling use of antimicrobial agents. Infect Control Hosp Epidemiol 1997;18:260–266.Google Scholar
18.John, JF Jr, Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471–485.Google Scholar
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;275:234–240.Google Scholar
20.Centers for Disease Control and Prevention. Reduced susceptibility of Staphylococcus aureus to vancomycin—Japan, 1996. MMWR 1997;46:624–626.Google Scholar
21.Centers for Disease Control and Prevention. Staphylococcus aureus with reduced susceptibility to vancomycin—US. MMWR 1997;46:765–766.Google Scholar