Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC)

ABSTRACT

This study evaluates vancomycin prescribing patterns in a tertiary-care hospital, with high prevalence of methicillin-resistant Staphylococcus aureus, comparing with the guidelines proposed by the Hospital Infection Control Practices Advisory Committee. The study was conducted in a 930-bed tertiary-care hospital, during 40 days (March 10 to April 30, 2003). Data were collected of all patients given vancomycin, using a standardized chart-extraction form designed. Inappropriate use was subdivided in five categories: empiric therapy without risk factors; continued empiric use for presumed infections in patients whose cultures were negative for beta-lactam-resistant Gram-positive microorganisms; treatment of infections caused by beta-lactam-sensitive Gram-positive microorganisms, without allergy history to beta-lactam antimicrobials; treatment in response to a single blood culture positive for coagulase-negative staphylococcus, if other blood cultures taken during the same time frame were negative; systemic or local prophylaxis for infection or colonization of indwelling central or peripheral intravascular catheters. Of 132 orders, 126 (95.4 percent) were considered to have been appropriate. Of these 126 prescriptions, 31 (24.6 percent) were administered for treatment of proven Gram-positive infections (78.1 percent of those were MRSA), 1 (0.8 percent) for beta-lactam allergy and 95 (75.4 percent) for empiric treatment of suspected Gram-positive infections. The majority of the patients (88.6 percent) have used antimicrobial recently (3 months). The mean pre-treatment hospitalization period was 14±15 days. Of the 132 treatments, 105 (79.5 percent) were nosocomial infections. In the institution analyzed, the vancomycin use was considered conscientious. Reduction in use of glycopeptide may be obtained by adaptations the CDC criteria, or by improvement of diagnostic criteria.