Improving Vancomycin Stewardship in Critically Ill Children.

Area of Science:

• Pediatric Intensive Care
• Infectious Diseases
• Quality Improvement

Background:

• Inappropriate vancomycin use is a recognized issue in pediatric healthcare settings.
• A quality improvement (QI) initiative was designed to address and reduce vancomycin utilization within a tertiary care Pediatric Intensive Care Unit (PICU).

Purpose of the Study:

• To quantify the prevalence of infections requiring vancomycin, including methicillin-resistant Staphylococcus aureus (MRSA).
• To implement and evaluate a multi-faceted QI intervention aimed at reducing vancomycin use in the PICU.
• To assess the impact of interventions on vancomycin Days of Therapy (DOT) and key safety indicators.

Main Methods:

• Retrospective analysis of infections requiring vancomycin therapy.
• Implementation of three QI interventions: stakeholder education, guideline development, and clinical decision support.
• Measurement of vancomycin DOT using statistical process control charts.
• Monitoring of balancing measures including bacteremia rates, mortality, and organ dysfunction.

Main Results:

• A 40% reduction in vancomycin DOT per 1000 patient days was observed over the 3-year QI project (from 182 to 109).
• Prevalence of infections requiring vancomycin was low (1.5%), with MRSA bacteremia at 0.5%.
• No significant changes were noted in balancing measures, indicating no increase in harm.

Conclusions:

• QI interventions effectively decreased vancomycin use in the PICU without adverse effects.
• Provider education and consensus-based guidelines were critical components for successful implementation.
• The study highlights the feasibility and safety of reducing vancomycin use through targeted QI strategies.