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Vancomycin Use in a University Medical Center: Comparison With Hospital Infection Control Practices Advisory Committee Guidelines

Published online by Cambridge University Press:  02 January 2015

Martin E. Evans  and
Kenneth J. Kortas
Martin E. Evans*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, School of Medicine, and the Department of Clinical Pharmacy Practice, University of Kentucky, School of Pharmacy, Lexington, Kentucky
Kenneth J. Kortas
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, School of Medicine, and the Department of Clinical Pharmacy Practice, University of Kentucky, School of Pharmacy, Lexington, Kentucky
*
Infection Control, HG608, University of Kentucky Medical Center, 800 Rose St, Lexington, KY 40536-0084
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Abstract

Objective: To compare actual vancomycin use in a hospital with the guidelines proposed by the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention.

Design: One-month prospective survey of all patients given vancomycin. Data were collected from patient and laboratory records and discussions with prescribing physicians.

Setting: Four hundred sixty-one–bed tertiary-care university hospital.

Results: Only 35% of the 101 vancomycin orders written during the audit were consistent with HICPAC guidelines. Twenty-eight patients were begun on vancomycin for the treatment of documented infections due to β-lactam–resistant gram-positive bacteria or because preliminary culture results suggested such bacteria were present. Seven methicillin-resistant Staphylococcus aureus, two ampicillin-resistant enterococci, and 10 coagulase-negative staphylococci were recovered. Vancomycin use was judged inappropriate in 66 patients. The drug was used empirically without obtaining appropriate cultures (44 patients), as surgical prophylaxis (6 patients), for primary treatment of antibiotic-associated colitis (3 patients), for convenience in a hemodialysis patient (1 patient), or for other reasons not recommended by HICPAC (12 patients).

Conclusions: Vancomycin use in our teaching center often was inconsistent with HICPAC guidelines. Information from the audit will be useful for designing strategies to improve vancomycin use.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 6 , June 1996 , pp. 356 - 359
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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