title: Impact of a series of interventions in vancomycin prescribing on use and prevalence of vancomycin-resistant enterococci.
abstract: BACKGROUND
  In response to vancomycin-resistant bacteria, particularly vancomycin-resistant enterococci (VRE), measures have been recommended to improve on the appropriate use of vancomycin.
  
  
  METHODS
  Intervention 1 consisted of an automatic 72-hour vancomycin stop order; Intervention 2, a standardized procedure for sampling of blood cultures; and Intervention 3, an interdisciplinary critical care team.
  
  
  RESULTS
  After Intervention 1, inappropriate use decreased, particularly in treatment of febrile neutropenia and undocumented gram-positive infections. After Intervention 2, the baseline rate of inappropriately drawn blood cultures (IDBCs) was unchanged, and use in patients with IDBCs was comparable during both periods. Before Intervention 3, 38/55 orders continuing > 72 hours were considered inappropriate versus 24/53 (p < .025) after. After the interventions, hospitalwide vancomycin use was reduced. Yet the overall rate of VRE infection initially decreased but then increased once again over time.
  
  
  CONCLUSIONS
  Despite substantial reduction in hospitalwide vancomycin use, the impact on the overall rate of VRE was inconsistent and ward dependent.
authors.affiliation: Department of Clinical Pharmacy, University of California San Francisco, USA. bjg@itsa.ucsf.edu
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Guglielmo
authors.forename: Vicky
authors.initials: V
authors.lastname: Dudas
authors.forename: Ila
authors.initials: I
authors.lastname: Maewal
authors.forename: Rebecca
authors.initials: R
authors.lastname: Young
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hilts
authors.forename: Mark
authors.initials: M
authors.lastname: Villmann
authors.forename: Laurel
authors.initials: L
authors.lastname: Gibbs
authors.forename: Michael
authors.initials: M
authors.lastname: Gropper
authors.forename: Richard
authors.initials: R
authors.lastname: Jacobs
mesh_terms: D002140:California; D011307:Drug Prescriptions / Q000592:standards; D016983:Enterococcus / Q000187:drug effects*; D006801:Humans; D011785:Quality Assurance, Health Care / Q000379:methods*; D014640:Vancomycin / Q000627:therapeutic use*; D020713:Vancomycin Resistance
chemical_list: D014640:Vancomycin