Vancomycin use in a hospital with vancomycin restriction

Area of Science:

• Infectious Diseases
• Hospital Pharmacy
• Antibiotic Stewardship

Background:

• Hospitals endemic for vancomycin-resistant enterococci (VRE) require strict antibiotic control measures.
• Vancomycin restriction programs are implemented to curb inappropriate vancomycin use and prevent VRE spread.

Purpose of the Study:

• To evaluate the effectiveness of a vancomycin restriction program in a hospital setting with endemic VRE.
• To identify patterns and reasons for inappropriate vancomycin prescribing.

Main Methods:

• Retrospective review of vancomycin prescriptions.
• Analysis of vancomycin usage appropriateness based on clinical indications and microbiological data.
• Assessment of antibiotic order changes after microbiological diagnosis.

Main Results:

• Only 68% of vancomycin prescriptions were deemed appropriate.
• Inappropriate vancomycin use was primarily driven by empirical therapy decisions.
• In 83% of cases with microbiological confirmation, infections were caused by bacteria susceptible to alternative antibiotics.
• Despite susceptibility to other agents, vancomycin orders were changed in only 60% of these patients.

Conclusions:

• The vancomycin restriction program showed limited success in optimizing vancomycin use.
• Empirical vancomycin therapy is a significant contributor to inappropriate prescribing.
• A substantial proportion of patients receiving inappropriate vancomycin could have been treated with narrower-spectrum antibiotics, indicating a need for enhanced antibiotic stewardship interventions.