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Glycopeptide prescribing in an Australian tertiary paediatric hospital
1Department of Paediatrics, Mater Children's Hospital, South Brisbane, Queensland, Australia. jonesda@mailbox.uq.edu.au
Insights
Inappropriate glycopeptide prescribing was common in a pediatric hospital, particularly for empiric use in oncology patients. Interventions are planned to address this issue and improve antibiotic stewardship.
Area of Science:
- Infectious Diseases
- Pediatric Pharmacology
- Antimicrobial Stewardship
Background:
- Glycopeptides are crucial for treating serious Gram-positive bacterial infections.
- Appropriate use of antibiotics like glycopeptides is essential to combat antimicrobial resistance.
- Guidelines from the Hospital Infection Control Practices Advisory Committee (HICPAC) and Infectious Diseases Society of America (IDSA) provide frameworks for appropriate antimicrobial use.
Purpose of the Study:
- To evaluate the extent and appropriateness of glycopeptide prescribing in a tertiary Australian pediatric hospital.
- To identify patterns and areas for improvement in glycopeptide utilization within a pediatric setting.
Main Methods:
- A retrospective analysis of glycopeptide prescriptions over a six-month period (July 1999-January 2000).
- Review of medical records to compare prescribing practices against HICPAC and IDSA guidelines.
- Assessment of appropriateness based on established criteria, including empiric therapy, prophylaxis, and therapeutic use.
Main Results:
- 98 glycopeptide prescriptions were analyzed for 51 patients, with 72.4% prescribed by the Haematology/Oncology unit.
- Vancomycin was the most common glycopeptide (69.4%), often used empirically (49%) or for prophylaxis (38.8%) in immunocompromised patients (70.4%) with central venous catheters (82.7%).
- Only 19.4% of prescriptions were deemed appropriate, and of those started appropriately, only 41.1% were continued correctly beyond 48 hours, resulting in an estimated cost of $9500 for inappropriate prescribing.
Conclusions:
- A significant rate of inappropriate glycopeptide prescribing was observed in the pediatric population studied.
- Inappropriate use was widespread across subspecialties, predominantly for empiric therapy and prophylaxis in pediatric oncology patients.
- Targeted education and ongoing audits are necessary to improve glycopeptide prescribing practices and antibiotic stewardship in this setting.
Objective:
To assess the extent and appropriateness of glycopeptide use in a tertiary Australian Paediatric hospital.
Methodology:
A retrospective analysis of prescriptions during a six-month period between July 1999 and January 2000. Medical records were examined and prescribing practices compared with the recommendations of the Hospital Infectious Control Practices Advisory Committee (HICPAC) and the Infectious Diseases Society of America (IDSA).
Results:
Fifty-one patients were identified who received a total of 98 glycopeptide prescriptions. The Haematology/ Oncology unit prescribed 71/98 (72.4%). 68/98 (69.4%) patients received vancomycin, 9/98 (9.2%) received teicoplanin and 21/98 (21.4%) a combination of both. 81/98 (82.7%) had central venous catheters and 69/98 (70.4%) were immunocompromised. 48/98 (49%) prescriptions were for empiric treatment with 38/98 (38.8%) for prophylaxis and 11/98 (12.2%) therapeutic. 19/98 (19.4%) prescriptions were deemed appropriate, 6 (6.1%) by HICPAC criteria, and a further 13 (13.3%) by IDSA or other criteria. Of 19 prescriptions started appropriately, only 7/17 (41.1%) were continued appropriately beyond 48 h. Appropriate cultures were taken before prescription in 93.3% of cases. Dose was appropriate in 91/98 (92.9%) and frequency appropriate in all cases. The cost of inappropriate prescribing was approximately $9500.
Discussion:
A high rate of inappropriate glycopeptide prescribing was evident in this paediatric population. Inappropriate prescribing existed across all subspecialties. Use was primarily for empiric therapy and prophylaxis in young children with an oncology diagnosis. A number of situations existed where glycopeptide prescription was felt appropriate despite not being included in HICPAC/IDSA guidelines. Areas with high rates of inappropriate prescribing were identified and will be targeted for education and intervention. Audit of practice continues.