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Evaluating Vancomycin Use at a Pediatric Hospital: New Approaches and Insights

Published online by Cambridge University Press:  21 June 2016

Maureen K. Bolon ,
Alana D. Arnold ,
Henry A. Feldman ,
David H. Rehkopf ,
Emily F. Strong ,
Donald A. Goldmann  and
Sharon B. Wright
Maureen K. Bolon*
Affiliation:
Division of Infectious Diseases, Children's Hospital Boston, Boston, Massachusetts Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Alana D. Arnold
Affiliation:
Department of Pharmacy, Children's Hospital Boston, Boston, Massachusetts
Henry A. Feldman
Affiliation:
Clinical Research Program, Children's Hospital Boston, Boston, Massachusetts
David H. Rehkopf
Affiliation:
Department of Health and Social Behavior, Harvard School of Public Health, Boston, Massachusetts
Emily F. Strong
Affiliation:
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
Donald A. Goldmann
Affiliation:
Division of Infectious Diseases, Children's Hospital Boston, Boston, Massachusetts
Sharon B. Wright
Affiliation:
Division of Infectious Diseases, Children's Hospital Boston, Boston, Massachusetts
*
Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 200, Chicago, IL 60611m-bolon@northwestern.edu
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Abstract

Objectives:

To characterize vancomycin use at a pediatric tertiary-care hospital, to discriminate between initial (≤ 72 hours) and prolonged (> 72 hours) inappropriate use, and to define patient characteristics associated with inappropriate use.

Design:

Vancomycin courses were retrospectively reviewed using an algorithm modeled on HICPAC guidelines. Data were collected regarding patient demographics, comorbidities, other medication use, and nosocomial infections. The association between each variable and the outcome of inappropriate use was determined by longitudinal regression analysis. A multi-variable model was constructed to assess risk factors for inappropriate initial and prolonged vancomycin use.

Setting:

A pediatric tertiary-care medical center.

Patients:

Children older than 1 year who received intravenous vancomycin from November 2000 to June 2001.

Results:

Three hundred twenty-seven vancomycin courses administered to 260 patients were evaluated for appropriateness. Of initial courses, 114 (35%) were considered inappropriate. Of 143 prolonged courses, 103 (72%) were considered inappropriate. Multivariable risk factor analysis identified the following variables as significantly associated with inappropriate initial use: admission to the surgery service, having a malignancy, receipt of a stem cell transplant, and having received a prior inappropriate course of vancomycin. No variables were identified as significant risk factors for inappropriate prolonged use.

Conclusions:

Substantial inappropriate use of vancomycin was identified. Prolonged inappropriate use was a particular problem. This risk factor analysis suggests that interventions targeting patients admitted to certain services or receiving multiple courses of vancomycin could reduce inappropriate use.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 1 , January 2005 , pp. 47 - 55
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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