Evaluating vancomycin use at a pediatric hospital: new approaches and insights.
OBJECTIVE
To characterize vancomycin use at a pediatric tertiary-care hospital, to discriminate between initial (< or = 72 hours) and prolonged (> 72 hours) inappropriate use, and to define patient characteristics associated with inappropriate use.


METHODS
Vancomycin courses were retrospectively reviewed using an algorithm modeled on HICPAC guidelines. Data were collected regarding patient demographics, comorbidities, other medication use, and nosocomial infections. The association between each variable and the outcome of inappropriate use was determined by longitudinal regression analysis. A multivariable model was constructed to assess risk factors for inappropriate initial and prolonged vancomycin use.


METHODS
A pediatric tertiary-care medical center.


METHODS
Children older than 1 year who received intravenous vancomycin from November 2000 to June 2001.


RESULTS
Three hundred twenty-seven vancomycin courses administered to 260 patients were evaluated for appropriateness. Of initial courses, 114 (35%) were considered inappropriate. Of 143 prolonged courses, 103 (72%) were considered inappropriate. Multivariable risk factor analysis identified the following variables as significantly associated with inappropriate initial use: admission to the surgery service, having a malignancy, receipt of a stem cell transplant, and having received a prior inappropriate course of vancomycin. No variables were identified as significant risk factors for inappropriate prolonged use.


CONCLUSIONS
Substantial inappropriate use of vancomycin was identified. Prolonged inappropriate use was a particular problem. This risk factor analysis suggests that interventions targeting patients admitted to certain services or receiving multiple courses of vancomycin could reduce inappropriate use.
Bolon
Maureen K
MK
Division of Infectious Diseases, Children's Hospital Boston, Boston, Massachusetts, USA. m-bolon@northwestern.edu
Arnold
Alana D
AD
Feldman
Henry A
HA
Rehkopf
David H
DH
Strong
Emily F
EF
Goldmann
Donald A
DA
Wright
Sharon B
SB
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D017723:Drug Utilization Review; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008508:Medication Errors; D010372:Pediatrics; D012307:Risk Factors; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin