Inappropriate continued empirical vancomycin use in a hospital with a high prevalence of methicillin-resistant Staphylococcus aureus.
Vancomycin is frequently inappropriately prescribed, especially as empirical treatment. The aim of this study was to evaluate (i) the amount of inappropriate continued empirical vancomycin use as a proportion of total vancomycin use and (ii) the risk factors associated with inappropriate continued empirical vancomycin use. We reviewed the medical records of adult patients who had been prescribed at least one dose of parenterally administered vancomycin between January and June 2012, in a single tertiary care hospital. When empirically prescribed vancomycin treatment was continued after 96 h without documentation of beta-lactam-resistant Gram-positive microorganisms in clinical specimens with significance, the continuation was considered inappropriate, and the amount used thereafter was considered inappropriately used. We identified risk factors associated with inappropriate continued empirical vancomycin use by multiple logistic regression. During the study period, the amount of parenterally administered vancomycin prescribed was 34.2 defined daily doses (DDDs)/1,000 patient-days (1,084 prescriptions for 971 patients). The amount of inappropriate continued empirical vancomycin use was 8.5 DDDs/1,000 patient-days, which represented 24.9% of the total parenterally administered vancomycin used (8.5/34.2 DDDs/1,000 patient-days). By multivariate analyses, inappropriate continued empirical vancomycin use was independently associated with the absence of any documented etiological organism (adjusted odds ratio [aOR], 1.60 [95% confidence interval {CI}, 1.06 to 2.41]) and suspected central nervous system (CNS) infections (aHR, 2.33 [95% CI, 1.20 to 4.50]). Higher Charlson's comorbidity index scores were inversely associated with inappropriate continued empirical vancomycin use (aHR, 0.90 [95% CI, 0.85 to 0.97]). Inappropriate continued empirical vancomycin use represented 24.9% of the total amount of vancomycin prescribed, which indicates room for improvement.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Nak-Hyun
NH
Kim
Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea.
Hei Lim
HL
Koo
Pyoeng Gyun
PG
Choe
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea.
Pyeong Gyun
PG
Choe
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Shinhye
S
Cheon
Moonsuk
M
Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Moon Suk
MS
Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Myung Jin
MJ
Lee
Younghee
Y
Jung
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Young Hee
YH
Jung
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Wan Beom
WB
Park
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Kyoung-Ho
KH
Song
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Eu Suk
ES
Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Ji Hwan
JH
Bang
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Hong Bin
HB
Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Sang Won
SW
Park
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea molder@unitel.co.kr.
Nam Joong
NJ
Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Myoung-don
MD
Oh
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Eui Chong
EC
Kim
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology*
D000900:Anti-Bacterial Agents; D014640:Vancomycin