title: Impact of an Antimicrobial Stewardship Program on Patient Safety in Veterans Prescribed Vancomycin.
abstract: OBJECTIVE
  This study aimed to determine the safety impact of an antimicrobial stewardship program (ASP) on vancomycin-associated nephrotoxicity and to examine risk factors contributing to the development of toxicity.
  
  
  METHODS
  This was a retrospective chart review of data from 453 veterans receiving vancomycin in the VA Western New York Healthcare System between October 2006 and July 2014. Nephrotoxicity was defined as an increase in serum creatinine of ≥ 0.5 mg/dL or by 50% of baseline for 2 consecutive days.
  
  
  RESULTS
  Patients receiving vancomycin after the implementation of the ASP were less likely to develop nephrotoxicity (odds ratio [OR] = 2.06; 95% CI, 1.02-4.28). Nephrotoxicity occurred in 6.84% of patients from the pre-ASP cohort and in 3.75% of patients after the implementation of the ASP. Predictors of nephrotoxicity included hospital service (surgical service, OR = 2.29; 95% CI, 1.13-4.64), elevated maximum trough concentration (unit OR = 1.15; 95% CI, 1.10-1.20), and concurrent piperacillin/tazobactam therapy (OR = 3.21; 95% CI, 1.43-7.96). The number of vancomycin trough concentration measurements per patient did not vary between the pre-ASP and ASP groups.
  
  
  CONCLUSIONS
  ASPs represent an important aspect of a patient-safety initiative in order to reduce vancomycin-associated nephrotoxicity. Concurrent piperacillin/tazobactam therapy, surgical service, and elevated maximum trough concentration were risk factors for nephrotoxicity.
authors.affiliation: Department of Infectious Diseases and Pharmacy, Veteran Affairs Western New York Healthcare System, Buffalo, New York.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Fodero
authors.affiliation: Department of Infectious Diseases and Pharmacy, Veteran Affairs Western New York Healthcare System, Buffalo, New York.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Horey
authors.affiliation: Department of Pharmacy Practice, The State University of New York, Buffalo, New York.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Krajewski
authors.affiliation: Department of Pharmacy Practice, The State University of New York, Buffalo, New York.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Ruh
authors.affiliation: Department of Infectious Diseases and Pharmacy, Veteran Affairs Western New York Healthcare System, Buffalo, New York; Department of Medicine, University at Buffalo, Buffalo, New York.
authors.forename: John A
authors.initials: JA
authors.lastname: Sellick
authors.affiliation: Department of Infectious Diseases and Pharmacy, Veteran Affairs Western New York Healthcare System, Buffalo, New York. Electronic address: kari.mergenhagen@va.gov.
authors.forename: Kari A
authors.initials: KA
authors.lastname: Mergenhagen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced*; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006748:Hospital Departments / Q000706:statistics & numerical data; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010397:Penicillanic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000009:adverse effects / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D014728:Veterans
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D014640:Vancomycin; D010397:Penicillanic Acid; D003404:Creatinine; D010878:Piperacillin
keywords: antimicrobial stewardship; nephrotoxicity; patient safety; vancomycin