title: Adherence to the 2009 consensus guidelines for vancomycin dosing and monitoring practices: a cross-sectional survey of U.S. hospitals.
abstract: OBJECTIVE
  To describe the implementation of vancomycin dosing and monitoring practices recommended by the consensus guidelines in a diverse sample of hospitals, and to identify needs for quality improvement and research.
  
  
  METHODS
  Cross-sectional study using an online survey instrument.
  
  
  METHODS
  Making a Difference in Infectious Diseases Pharmacotherapy (MAD-ID) Research Network.
  
  
  METHODS
  A total of 163 respondents from MAD-ID who work in antimicrobial stewardship and represent unique hospitals.
  
  
  RESULTS
  The survey population represented a wide range of patient populations (96% adult, 49% pediatric, and 23% long-term care) and settings (52% not-for-profit nonuniversity, 31% university based, and 11% for profit). Automatic consultation of pharmacy services for all vancomycin dosing was reported in 51% of the institutions. Among the dosing and monitoring practices endorsed by the consensus guidelines, participant institutions commonly followed these recommendations: use of trough concentrations without peak concentrations, maintenance of trough concentration higher than 10 mg/L, and target trough concentrations of 15-20 mg/L for complicated infections. In contrast, there was less consistent application of appropriate timing of trough concentrations, use of loading doses, and use of actual body weight. The remaining challenges and controversies surrounding vancomycin dosing are discussed.
  
  
  CONCLUSIONS
  Despite the availability of consensus guideline recommendations, practices for dosing and monitoring of vancomycin are not universally applied. The findings of this survey highlight many opportunities for future research and quality improvement strategies.
authors.affiliation: Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan; Henry Ford Hospital, Detroit, Michigan.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Davis
authors.forename: Marc H
authors.initials: MH
authors.lastname: Scheetz
authors.forename: John A
authors.initials: JA
authors.lastname: Bosso
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goff
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rybak
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D019983:Guideline Adherence; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D014481:United States; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Vancomycin; clinical pharmacy services; survey; therapeutic drug monitoring