Does vancomycin prescribing intervention affect vancomycin-resistant enterococcus infection and colonization in...

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Antimicrobial Stewardship

Background:

• Vancomycin-resistant enterococcus (VRE) is a significant cause of hospital-acquired infections in the US.
• VRE is associated with increased patient morbidity, mortality, and healthcare costs compared to vancomycin-susceptible strains.
• Prudent vancomycin use is recommended for VRE control, but population-level impact of reduced vancomycin usage is unknown.

Purpose of the Study:

• To systematically review the impact of reduced vancomycin use on VRE prevalence and incidence in US hospitals.
• To assess the effectiveness of prescribing interventions aimed at decreasing vancomycin utilization.

Main Methods:

• A systematic review of 13 studies from 12 articles was conducted.
• Studies were identified through electronic database searches and journal hand-searching.
• Data on study setting, design, interventions, and outcomes were extracted; relative risks and confidence intervals were calculated.

Main Results:

• No randomized clinical trials were identified; all studies used quasi-experimental designs.
• Seven of 13 studies reported significant VRE reductions, while three reported increases.
• Studies on specific wards with sicker patients were more likely to show positive results than those on general hospital wards.

Conclusions:

• The role of vancomycin reduction in controlling VRE in US hospitals remains inconclusive.
• Study heterogeneity and quality limit definitive conclusions on intervention effectiveness and sustainability.
• High-quality research with robust designs is needed to clarify the impact of vancomycin reduction strategies.