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A new approach to Vancomycin utilization evaluation: A cross-sectional study in intensive care unit
Atefeh Mahmoodian1, Saeed Abbasi2, Shadi Farsaei3
1Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran.
Objective:
The risk of methicillin-resistant Staphylococcus aureus infections in Intensive Care Unit (ICU) is increasing in recent years with high rate of morbidity and mortality. Therefore, in this study, we aimed to evaluate the rationale use of vancomycin in ICU patients.
Methods:
A total of 200 patients who received at least 48 h intravenous vancomycin were randomly selected from ICU wards, during 9 months. Vancomycin administration and related clinical and laboratory data were gathered from patients' charts and health information system to evaluate the appropriateness of different aspects of vancomycin use during all days which vancomycin were ordered.
Findings:
During the study, 15,230 ± 1216 mg (mean ± standard error of the mean [SEM]) vancomycin was administered for 200 patients in the mean period of 9.79 ± 0.64 (SEM) days of ICU stay, for prophylaxis and empiric therapy. Results showed the appropriateness of vancomycin uses were 30.5%, 9%, and 5.5% in the first 24 h, after 72 h and during the whole time of treatment, respectively. In addition, infectious consultation was the only significantly different parameter between appropriate and inappropriate vancomycin administration groups (P < 0.001).
Conclusion:
Although vancomycin utilization evaluation were mentioned in previous studies, but data related to ICU patients and during all days of vancomycin therapy are limited. High prevalence of inappropriate use of vancomycin in ICU is alarming for health systems and necessitates implementation of antibiotic policies.
Insights
High rates of inappropriate vancomycin use in Intensive Care Units (ICUs) are concerning. This study highlights the urgent need for antibiotic stewardship policies to ensure appropriate vancomycin administration in critical care settings.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant threat in ICUs, leading to increased morbidity and mortality.
- Vancomycin is a crucial antibiotic for treating MRSA, but its effectiveness is threatened by rising resistance and inappropriate use.
Purpose of the Study:
- To evaluate the appropriateness of vancomycin use in Intensive Care Unit (ICU) patients.
- To identify factors influencing appropriate vancomycin administration during the entire course of therapy.
Main Methods:
- A retrospective study involving 200 ICU patients who received vancomycin for at least 48 hours.
- Data collection included vancomycin administration details, clinical outcomes, and laboratory results from patient charts and health information systems.
Main Results:
- Vancomycin appropriateness was low: 30.5% in the first 24 hours, 9% after 72 hours, and 5.5% throughout treatment.
- Infectious disease consultation was the only factor significantly associated with appropriate vancomycin use (P < 0.001).
Conclusions:
- The study reveals a high prevalence of inappropriate vancomycin use in ICUs, underscoring a critical issue for healthcare systems.
- Implementation of robust antibiotic stewardship programs and policies is essential to optimize vancomycin therapy and combat antimicrobial resistance.
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