Appropriateness of intravenous vancomycin prescribing in a Canadian acute care hospital

There are associated adverse effects with intravenous (IV) vancomycin, yet there is a paucity of published literature surveying the appropriateness of use. The objective of the study was to assess the appropriateness of IV vancomycin prescriptions at a Canadian acute care hospital.

A pilot, pragmatic antimicrobial stewardship initiative using prospective audit and feedback (PAF) was conducted on incident IV vancomycin prescriptions for 4 weeks in 2022. The primary outcome was the percentage of IV vancomycin prescriptions assessed as appropriate against institutional prescribing guidelines. The secondary outcomes were to evaluate factors affecting appropriateness and to determine the number and types of ASP recommendations where IV vancomycin was assessed as suboptimal.

Out of 109 prescriptions audited, 43 (39%) were assessed to be suboptimal. Discontinuing or changing the agent was recommended in 39 cases (91%) and regimen optimization (duration or frequency change) was only recommended in only 4 (9%). ASP recommendations were fully or partially accepted in 88%. Infectious disease consultation (IDC) was associated with greater appropriateness (83% versus 53%; p = 0.004), as was Methicillin resistant Staphylococcus aureus (MRSA) colonization (75% versus 55%; p = 0.047), but not acute kidney injury (AKI) (62% versus 60%; p = 0.889). Adjusting for age, AKI and MRSA colonization, IDC remained a significant predictor of vancomycin appropriateness (adjusted odds ratio [aOR] = 4.27, [95% CI 1.44 to 12.70]; p = 0.009).

Prospective audit and feedback demonstrated inappropriate IV vancomycin use at our centre and an opportunity for quality improvement.