Vancomycin Use in a Brazilian University Hospital: Comparison With Hospital Infection Control Practices Advisory...

Emergence of vancomycin-resistant bacteria is of concern. In an effort to reduce this danger, guidelines to ensure proper prescribing of vancomycin have been proposed by the Hospital Infections Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control. To evaluate use of vancomycin at Uberlândia University Hospital in Brazil, each patient who received the drug during a 10 month period had nasal and rectal cultures done within 48 hours of initiation of therapy, then at weekly intervals until discharge. Their hospital records were reviewed to obtain demographic and clinical data, and each was scored as to whether or not HICPAC guidelines were followed. Thirty-one patients were enrolled in the study; 15 of whom had been approved for vancomycin by the hospital infectious diseases (ID) specialist, and 16 who had the drug given without approval. During the study, 4 strains of VRE (Vancomycin Resistant Knterococci) and 8 strains of MRSA(Methicillin Resistant S.aureus) emerged. The use of vancomycin did not follow HICPAC guidelines in 21/31 patients (68%), in that the drug was prescribed empirically without prior documentation of need. This occurred 13 of 16 (81%) times when no approval by an ID specialist was provided, and 8 of 15 times (53%)after approval by a ID specialist. In 6 of 8 patients (75%), empirical use of vancomycin was approved by an ID specialist in patients with severe illnesses, each of whom subsequently died. This could be considered appropriate use, although outside the guidelines. Only 3 of 13 patients (23%) were severely ill when vancomycin was used without ID approval. Most of the vancomycin use which did not follow HICPAC guidelines occurred on the medicine service in patients moderately ill with pneumonia or bacteremia, and associated with invasive procedures. We conclude that there is a special need to improve education regarding the appropriate use of vancomycin and to increase review of its use by an ID specialist, particularly on medicine services of our hospital.