Analysis of vancomycin use and associated risk factors in a university teaching hospital: a prospective cohort study.
BACKGROUND
Vancomycin use is considered inappropriate in most hospitals. A particular concern is the recent emergence of S. aureus with decreased susceptibility to vancomycin, making it important to reduce overall exposure to vancomycin to minimize the incidence of VRE (vancomycin-resistant enterococci). The aim of this work was to analyze the use of vancomycin and the risk factors associated with inappropriate treatment.


METHODS
A prospective survey was conducted on all patients receiving vancomycin between 1st March 2002 and 30th September 2002 in a university-school hospital. Appropriateness of vancomycin use was assessed, according to the criteria established by the Centers for Disease Control and Prevention (CDC), at two time points: first, at the beginning of therapy, and second, continuing after 72 hours.


RESULTS
A total of 557 patients received vancomycin. Three hundred seventy-four (67.1%) were under 60 years old, 374 (67.1%) had prolonged stays (>two weeks) in hospital, and 455 (81.7%) were in the intensive care unit (ICU). Two hundred sixty-three patients (47.2%) had some invasive device. In 324 (58.2%) patients the duration of vancomycin treatment was up to two weeks. Vancomycin was inappropriately used in 65.7% during the first 24 hours and in 67% at the 72 hours point according to CDC criteria 4. The inappropriateness of vancomycin use during the first 24 hours was related to: patients aged less than 60 (OR 1.7; CI 95% 1.1-2.5), non-ICU patients (OR 1.5; CI 95% 1.0-2.4) and patients without neutropenia (OR 7.5; CI 95% 2.4-22.7). At 72 hours, the inappropriateness of vancomycin use was related to: patients aged less than 60 (OR 1.5; CI 95% 1.0-2.3), non-ICU patients (OR 1.7; CI 95% 1.1-2.7) and patients without neutropenia (OR 8.0; CI 95% 2.6-24.3).


CONCLUSIONS
Vancomycin was abused. Patients aged less than 60, non-ICU patients and those who did not present neutropenia were the principal groups at risk of inappropriate use.
Department of Infectious Disease, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. moacyrjunior8@hotmail.com
Moacyr S
MS
Junior
Luci
L
Correa
Alexandre R
AR
Marra
Luis F A
LF
Camargo
Carlos A P
CA
Pereira
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001938:Brazil; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy*; D004358:Drug Therapy / Q000706:statistics & numerical data; D005260:Female; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage*; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D014640:Vancomycin