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Vancomycin and home health care
Thomas G Fraser1, Valentina Stosor, Qiong Wang
1Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Emerging Infectious Diseases
|December 2, 2005
Summary
Many outpatients receive vancomycin inappropriately at home, often due to extended use and convenience. Appropriate vancomycin use in homecare settings requires better adherence to guidelines to combat antimicrobial resistance.
Area of Science:
- Infectious Diseases
- Pharmacology
- Public Health
Background:
- Antimicrobial resistance is a growing concern, necessitating prudent use of antibiotics like vancomycin.
- Hospital Infection Control Practices Advisory Committee guidelines aim to optimize vancomycin usage.
- Previous compliance studies focused mainly on hospitalized patients, overlooking homecare settings.
Purpose of the Study:
- To evaluate parenteral vancomycin use in outpatients receiving homecare.
- To identify factors associated with appropriate and inappropriate vancomycin administration in homecare settings.
Main Methods:
- Retrospective cohort study design.
- Analysis of vancomycin use in patients receiving treatment through a homecare agency.
- Identification of reasons for off-guideline vancomycin administration.
Main Results:
- 39.2% of outpatients received vancomycin outside established guidelines.
- Common reasons for inappropriate use included prolonged empiric therapy, dosing convenience, and extended post-surgical use.
- Appropriate vancomycin use was more likely in patients >65 years, with a history of malignancy, or discharged from medical services.
- Wound cultures and microbiologic diagnosis correlated with more appropriate vancomycin prescribing.
Conclusions:
- Vancomycin prescribing guidelines are frequently overlooked in home infusion settings.
- Factors influencing appropriate vancomycin use in outpatients were identified.
- Further research is needed to understand the public health impact of home vancomycin use.