Related Experiment Videos
Effect of a vancomycin restriction policy on ordering practices during an outbreak of vancomycin-resistant
A M Anglim1, B Klym, K E Byers
1Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville, USA.
Background:
With the development of nosocomial pathogens that are resistant to multiple antimicrobial agents, reasonable restriction of antibiotic use has become a priority.
Methods:
During an outbreak of vancomycin-resistant enterococcal infections, an audit of vancomycin hydrochloride use was conducted during October 3 through 21, 1994, and January 24 through February 2, 1995. During these periods, all orders for vancomycin were reviewed by clinical pharmacists. Use was classified as either appropriate or inappropriate based on recommendations by the Hospital Infection Control Practice Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention, Atlanta, Ga. A policy restricting the use of vancomycin was adopted in November 1994.
Results:
During the first audit in October 1994, 61% of vancomycin orders were considered inappropriate according to HICPAC criteria. At the time of this audit, the first cases of an outbreak of nosocomial vancomycin-resistant Enterococcus faecium had been detected. The follow-up audit showed that 30% of vancomycin orders were inappropriate by HICPAC criteria (P < .001). Overall use of vancomycin decreased by 50% and remained at this lower level for the following year.
Conclusion:
The institution of a vancomycin restriction policy was associated with a reduction of both inappropriate drug orders and total use.
Insights
Implementing a vancomycin restriction policy significantly reduced inappropriate antibiotic orders and overall vancomycin use during a nosocomial outbreak of vancomycin-resistant enterococci. This highlights the importance of antibiotic stewardship.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Hospital Epidemiology
Background:
- Rising rates of multidrug-resistant nosocomial pathogens necessitate judicious antibiotic use.
- Vancomycin-resistant enterococcal (VRE) infections pose a significant healthcare challenge.
Purpose of the Study:
- To evaluate the impact of a vancomycin restriction policy on its use during a VRE outbreak.
- To assess the appropriateness of vancomycin orders before and after policy implementation.
Main Methods:
- An audit of vancomycin hydrochloride orders was conducted during two periods in 1994-1995.
- Clinical pharmacists reviewed vancomycin orders against Hospital Infection Control Practice Advisory Committee (HICPAC) criteria.
- A policy restricting vancomycin use was implemented in November 1994.
Main Results:
- Initially, 61% of vancomycin orders were deemed inappropriate, coinciding with the detection of VRE cases.
- Following the restriction policy, inappropriate vancomycin orders decreased to 30% (P < .001).
- Overall vancomycin use decreased by 50% and was sustained at this lower level.
Conclusions:
- A vancomycin restriction policy effectively reduced inappropriate vancomycin prescribing.
- The policy contributed to a significant decrease in overall vancomycin utilization.
- Antimicrobial stewardship interventions are crucial for controlling resistant infections.