Vancomycin overuse in Siriraj Hospital.

OBJECTIVE: An emergence of vancomycin resistant organisms particularly vancomycin-resistant enterococci (VRE) has become a serious public health concern. To prevent and control the spread of vancomycin resistant organisms, the prudent use of vancomycin is strongly recommended by the Hospital Infection Control Practices Advisory Committee (HICPAC). MATERIAL AND METHOD: A 6-week prospective observational study of vancomycin use was conducted in hospitalized patients at Siriraj Hospital from February to March 2005. Indications of initiating and continuing vancomycin were categorized according to HICPAC recommendations. Factors related to the appropriateness of vancomycin use were also evaluated. RESULTS: At initiation, vancomycin was inappropriately and empirically prescribed 19/222 times (8.6%) and 166/222 times (74.8%), respectively. After microbiological results were obtained, the rate of inappropriate prescription continued 132/222 times (59.5%). Furthermore, inappropriate use was significantly correlated with the type of department. There was a higher rate in the Department of Pediatrics, Surgery and Ophthalmology when compared with that of the Department of Medicine (p = 0.001). The inappropriate use also correlated with topical use (p < 0.001), intravenous administration (p = 0.012) and no consultation with an infectious disease specialist (p = 0.001). The overuse did not improve the clinical outcome. CONCLUSION: A substantial rate of inappropriate use of vancomycin was found in Siriraj Hospital. Intervention to improve appropriateness of vancomycin use should be urgently implemented to prevent and control the emergence of vancomycin resistant organisms.

Epidemiology of Staphylococcus aureus infections and the prevalence of infection caused by community-acquired methicillin-resistant Staphylococcus aureus in hospitalized patients at Siriraj Hospital.

BACKGROUND: The CA-MRSA infections have emerged in many parts of the world over the past decade. To our knowledge, the prevalence of CA-MRSA infections in Thai patients is unknown. OBJECTIVE: To determine an epidemiology of Staphylococcus aureus (S. aureus) infections in hospitalized patients in Siriraj Hospital and the prevalence of infections caused by community-acquired methicillin-resistant S. aureus (CA-MRSA). MATERIAL AND METHOD: The study was carried out at Siriraj Hospital from January to May 2005. The eligible patients were hospitalized patients whom S. aureus were isolated from their clinical specimens submitted to Department of Microbiology. S. aureus isolate was classified into infection or colonization. S. aureus infections were further classified into methicillin-resistant S. aureus (MRSA) or methicillin-sensitive S. aureus (MSSA) infections, and hospital-acquired (HA) or community-acquired (CA) infections. CA-MRSA infection is defined as infection caused by MRSA isolated from the patient within 72-hour of hospitalization and has no features of HA MRSA infections. RESULTS: There were 669 S. aureus isolates from 448 patients. Two hundred and sixty two patients (58.5%) were MSSA whereas 186 (41.5%) were MRSA infections. CA-MRSA was found in three isolates (0.9% of total MRSA) from two patients. CONCLUSION: The prevalence of CA-MRSA infections in hospitalized patients in Siriraj Hospital was uncommon and these patients could probably be HA MRSA infections.