title: Monitoring antimicrobial use and resistance: comparison with a national benchmark on reducing vancomycin use and vancomycin-resistant enterococci.
abstract: To determine if local monitoring data on vancomycin use directed quality improvement and decreased vancomycin use or vancomycin-resistant enterococci (VRE), we analyzed data from 50 intensive-care units (ICUs) at 20 U.S. hospitals reporting data on antimicrobial-resistant organisms and antimicrobial agent use. We compared local data with national benchmark data (aggregated from all study hospitals). After data were adjusted for changes in prevalence of methicillin-resistant Staphylococcus aureus, changes in specific prescriber practice at ICUs were associated with significant decreases in vancomycin use (mean decrease -48 defined daily doses per 1,000 patient days, p<0.001). These ICUs also reported significant decreases in VRE prevalence compared with those not using unit-specific changes in practice (mean decrease of 7.5% compared with mean increase of 5.7%, p<0.001). In this study, practice changes focused towards specific ICUs were associated with decreases in ICU vancomycin use and VRE prevalence.
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. skf0@cdc.gov
authors.forename: Scott K
authors.initials: SK
authors.lastname: Fridkin
authors.forename: Rachel
authors.initials: R
authors.lastname: Lawton
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Edwards
authors.forename: Fred C
authors.initials: FC
authors.lastname: Tenover
authors.forename: John E
authors.initials: JE
authors.lastname: McGowan
authors.forename: Robert P
authors.initials: RP
authors.lastname: Gaynes
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D019985:Benchmarking; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D016983:Enterococcus / Q000187:drug effects* / Q000502:physiology; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D008712:Methicillin / Q000494:pharmacology; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D014481:United States; D014640:Vancomycin / Q000494:pharmacology*; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D008712:Methicillin