Appropriate vancomycin use in a Malaysian tertiary hospital based on current HICPAC recommendations

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Microbiology

Background:

• Antibiotic resistance, particularly methicillin-resistant Staphylococcus aureus (MRSA), is a growing global health concern.
• Vancomycin is a critical antibiotic, and its judicious use is essential to prevent the emergence of vancomycin-resistant organisms.
• Cost-effectiveness is a key consideration for antibiotic use in developing countries.

Purpose of the Study:

• To evaluate the appropriate use of vancomycin according to Healthcare Infection Control Practices Advisory Committee (HICPAC) guidelines.
• To investigate vancomycin serum levels in patients receiving the antibiotic.
• To identify patterns of vancomycin misuse and their potential contribution to resistance.

Main Methods:

• Retrospective analysis of medical records for patients treated with vancomycin over one year.
• Categorization of vancomycin use into treatment and prophylaxis.
• Assessment of vancomycin appropriateness based on HICPAC guidelines and review of therapeutic drug monitoring data.

Main Results:

• Of 118 patients, 67% (n=79) received vancomycin appropriately, while 33.1% (n=39) had inappropriate use.
• The most frequent reason for inappropriate use was non-neutropenic, non-line related sepsis (30.8%).
• Therapeutic drug monitoring was performed in 67% of patients, with 67% showing sub-therapeutic levels on initial measurement; no dose-dependent difference in trough levels was observed.

Conclusions:

• A significant proportion of vancomycin use remains inappropriate, posing a risk for the development of antibiotic resistance.
• Sub-therapeutic vancomycin levels in many patients may indicate suboptimal dosing or monitoring strategies.
• Adherence to HICPAC guidelines and optimized therapeutic drug monitoring are crucial for effective vancomycin therapy and resistance containment.