title: Vancomycin Use: Room for Improvement Among Hospitalized Children.
abstract: BACKGROUND
  The use of vancomycin is common among hospitalized children. We sought to evaluate the impact of prospective audit with real-time feedback on vancomycin use and pharmacy costs.
  
  
  METHODS
  Vancomycin use was evaluated at Monroe Carell Jr Children's Hospital at Vanderbilt (MCJCHV) before and after the implementation of prospective audit with intervention and feedback to providers in 2012. Antibiotic use was compared to academic children's hospitals with established antimicrobial stewardship programs (ASPs). Two similar pediatric academic institutions without an ASP were used as nonintervention controls. Analysis of monthly days of antibiotic therapy (DoT) per 1000 patient-days was performed by interrupted time series analysis.
  
  
  RESULTS
  Monthly vancomycin use decreased from 114 DoTs/1000 patient-days to 89 DoTs/1000 patient-days ( P < .0001). We did not find significant differences in the slope of change in vancomycin use between MCJCHV and institutions with ASPs either before or after the intervention ( P = .86 and P = .71, respectively). When compared to children's hospitals without ASPs, the use of vancomycin was significantly lower at MCJCHV ( P < .001).
  
  
  CONCLUSIONS
  The use of vancomycin at academic children's hospitals with an ASP is declining. In our experience, prospective audit with real-time intervention and feedback to providers significantly reduced the use and costs associated with vancomycin.
authors.affiliation: 1 Department of Pharmacy, Monroe Carell Jr Hospital for Children, Nashville, TN, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gillon
authors.affiliation: 2 Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Meng
authors.initials: M
authors.lastname: Xu
authors.affiliation: 2 Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: James
authors.initials: J
authors.lastname: Slaughter
authors.affiliation: 3 Infectious Diseases Division, Department of Pediatrics, Vanderbilt University, Nashville, TN, USA.
authors.forename: M Cecilia
authors.initials: MC
authors.lastname: Di Pentima
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D002648:Child; D002673:Child, Hospitalized; D017723:Drug Utilization Review / Q000191:economics* / Q000379:methods; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D011446:Prospective Studies; D014640:Vancomycin / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: pediatrics; stewardship; vancomycin