Reduced Intravenous Vancomycin Use and Cost Savings in a Pediatric Hemodialysis Unit: A Quality Report

Intravenous (IV) vancomycin is used in patients receiving chronic hemodialysis (HD) for the treatment of central venous catheter-related infections. Excessive use of IV vancomycin leads to high costs and an increase in multidrug-resistant organisms. Our primary aim was to reduce IV vancomycin use for suspected central venous catheter-related infections in our pediatric chronic HD unit by 50% within 1 year. Our secondary aim was to reduce the total cost of IV vancomycin use by 50%.

With a quality improvement framework, the key interventions include (1) provider education on antibiotic stewardship, related to IV vancomycin and its associated risks; (2) identification of alternative topical/enteral antibiotics; (3) development and implementation of an exit-site scoring tool; and (4) development of a treatment-based algorithm to standardize choice of antibiotic related to exit-site score.

We used a statistical process control chart to demonstrate that IV vancomycin use declined from an average of 24 doses per 1,000 patient-days in the preintervention period (August 1, 2018, to August 31, 2019) to 5.1 vancomycin doses per 1,000 patient-days in the postintervention period (September 1, 2019, to July 31, 2020). Additionally, the IV vancomycin cost decreased from $81,297 per 1,000 patient-days during the preintervention period to $14,053 per 1,000 patient-days during the postintervention period.

A stepwise incorporation of interventions, including education, the development of a novel exit-site scoring tool, and a treatment-based algorithm, resulted in a 78% decrease in IV vancomycin use in our pediatric chronic HD unit within 1 year and an 82% decrease in associated costs.