title: Effectiveness of a guideline to reduce vancomycin use in the neonatal intensive care unit.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention recommend hospitals develop guidelines for the appropriate use of vancomycin as part of comprehensive antimicrobial stewardship. The objective of this study was to evaluate the effectiveness and safety of a guideline to restrict vancomycin use in the neonatal intensive care unit (NICU).
  
  
  METHODS
  A vancomycin use guideline was introduced in 2 tertiary care NICUs with low incidences of methicillin-resistant Staphylococcus aureus infections. We compared all infants >72 hours of age who were evaluated for late-onset infection before and after implementation of this guideline.
  
  
  RESULTS
  Vancomycin start rates were reduced from 6.9 to 4.5 per 1000 patient-days (35% reduction; P = 0.01) at Brigham and Women's Hospital, and from 17 to 6.4 per 1000 patient-days (62% reduction; P < 0.0001) at Massachusetts General Hospital. The number of infants exposed to vancomycin decreased from 5.2 to 3.1 per 1000 patient-days (40% reduction; P = 0.008) at Brigham and Women's Hospital, and 10.8 to 5.5 per 1000 patient-days (49% reduction; P = 0.009) at Massachusetts General Hospital. Causes of infection, duration of bacteremia, and incidence of complications or deaths attributable to late-onset infection did not change significantly at either institution.
  
  
  CONCLUSIONS
  Implementation of a NICU vancomycin use guideline significantly reduced exposure of newborns to vancomycin without adversely affecting short-term patient safety. Further studies are required to evaluate the long-term effect of vancomycin restriction on NICU patient safety and microbial ecology, particularly among institutions with higher rates of methicillin-resistant Staphylococcus aureus infections.
authors.affiliation: Division of Newborn Medicine, Children's Hospital, Boston, MA, USA.
authors.forename: Chia-Hua
authors.initials: CH
authors.lastname: Chiu
authors.forename: Ian C
authors.initials: IC
authors.lastname: Michelow
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cronin
authors.forename: Steven A
authors.initials: SA
authors.lastname: Ringer
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ferris
authors.forename: Karen M
authors.initials: KM
authors.lastname: Puopolo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D004363:Drug Utilization / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods; D008404:Massachusetts; D016134:Organizational Policy; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin