Empiric Vancomycin Reduction in a Pediatric Intensive Care Unit.

Area of Science:

• Pediatric critical care medicine
• Infectious disease epidemiology
• Antimicrobial stewardship

Background:

• Empirical vancomycin overuse in pediatric intensive care units (PICUs) for community-acquired infections (CAIs) is driven by high local rates of methicillin-resistant *Staphylococcus aureus* (MRSA).
• The study aimed to decrease unnecessary vancomycin administration for CAIs in the PICU.

Purpose of the Study:

• To implement and evaluate evidence-based indications for empirical vancomycin use in pediatric CAIs.
• To achieve a 30% reduction in empirical vancomycin use within the PICU.

Main Methods:

• Developed MRSA-risk-factor-based vancomycin indications for suspected CAIs.
• Implemented indications with provider education and revised antibiotic order sets.
• Tracked vancomycin use using statistical process control and monitored MRSA infection rates as balancing measures.

Main Results:

• Empirical vancomycin use for CAIs in the PICU decreased by 38% (from 73% to 45%) after intervention.
• No patients initially not receiving vancomycin required MRSA-targeted therapy later.
• No significant changes were observed in nephrotoxicity or MRSA infection rates.

Conclusions:

• Clear, data-validated recommendations combined with education and decision support effectively and safely reduced vancomycin use in the PICU.
• Retrospective validation of guidelines with local data was crucial for clinician acceptance and successful implementation.