Assessment of vancomycin use in chronic haemodialysis patients: room for improvement.
BACKGROUND
Vancomycin is frequently prescribed for the management of infections in haemodialysis patients. We evaluated the appropriateness of vancomycin use in our chronic haemodialysis population.


METHODS
Charts of all chronic haemodialysis patients who received vancomycin between 1 March 2003 and 1 March 2004 were retrospectively reviewed. Indication was assessed according to the modified Hospital Infection Control Practices Advisory Committee guidelines for vancomycin prescription. The prescribed dosing regimens were evaluated.


RESULTS
A total of 163 courses of vancomycin in 105 patients were assessed. Of all courses, 88% were considered to be initially appropriate, but this decreased to 63% once culture and sensitivity results were available. Use of vancomycin for the management of beta-lactam-sensitive organisms accounted for the majority of inappropriate use. The most common vancomycin-dosing regimen prescribed was 500 mg intravenously at each haemodialysis session (51%); however, considerable variability was observed.


CONCLUSIONS
Although the initial indication for vancomycin use was generally appropriate, inappropriate continuation of this antibiotic, failure to obtain proper cultures to guide therapy and potentially subtherapeutic dosing regimens were some of the challenges identified. Centres providing chronic haemodialysis should take steps to optimize vancomycin prescription to improve clinical outcomes and reduce the risk of antimicrobial resistance.
Zvonar
Rosemary
R
Pharmacy Department, The Ottawa Hospital, Ottawa, Ontario , Canada. rzvonar@ottawahospital.on.ca
Natarajan
Sabrina
S
Edwards
Cedric
C
Roth
Virginia
V
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002408:Catheters, Indwelling / Q000382:microbiology; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy*; D008297:Male; D017063:Outcome Assessment, Health Care; D006435:Renal Dialysis; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology; D013211:Staphylococcus aureus; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin