Evaluation of glycopeptide use in nine French hospitals.
BACKGROUND
Adequate glycopeptide use is necessary to optimize efficacy and minimize adverse events and selection of drug resistant microorganisms.


METHODS
We performed a multicenter prospective observational study of glycopeptides indications based on modified HICPAC criteria, and quality of prescription based on French consensus recommendations. We assessed the adequacy of indications, loading dose, maintenance dose, administration frequency, serum monitoring and its consequences.


RESULTS
We evaluated 117 curative adult prescriptions from nine hospitals. Glycopeptide indications were adequate in 71% with either a clinical (55%) or microbiological justification (27%). The indication was more frequently adequate for vancomycin than for teicoplanin (77% vs. 60%, p=0.04). De-escalation therapy was performed in 48% of all documented infections and 78% of documented infections with betalactam susceptible strains. We observed high rates of correct maintenance dose (90%), administration frequency (88%), and serum monitoring (74%). Loading doses (43%), adequate serum monitoring timing (43%), correction of dose because of inadequate levels (32%) were less adequate. Overall, only three (3%) treatments were adequate for all evaluated items.


CONCLUSIONS
Glycopeptide indications were adequate. However, the quality of prescription can be improved and should focus on loading doses and serum monitoring.
Alfandari
S
S
Service de réanimation et maladies infectieuses, centre hospitalier, 155, rue du Président Coty, 59208 Tourcoing, France. alfandari.s@gmail.com
Levent
T
T
Descamps
D
D
Hendricx
S
S
Bonenfant
C
C
Taines
V
V
Cattoen
C
C
Arimane
O
O
Grandbastien
B
B
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D003428:Cross Infection / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004352:Drug Resistance, Microbial; D017723:Drug Utilization Review; D005602:France; D019983:Guideline Adherence; D006761:Hospitals / Q000706:statistics & numerical data*; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D011446:Prospective Studies; D017334:Teicoplanin / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D014640:Vancomycin