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Manish M. Tiwari
Manish M. Tiwari
Several studies have documented increased rates of MRSA associated with adverse patient outcomes. Vancomycin remains the primary treatment of choice and use of vancomycin in hospitalized settings is increasing. Inappropriate vancomycin has been shown to lead to the development of vancomycin resistant organisms. Guidelines developed by IDSA have been used to promote appropriate use of vancomycin. However, inappropriate use of vancomycin remains high and its association with patient outcomes has not been well examined. The objective of this study was to examine appropriateness of vancomycin use and associated outcomes based on IDSA guidelines.
A retrospective observational study of patients ≥18 years old who had received one dose of intravenous vancomycin in January 2019 was conducted at the University of Nebraska Medical Center. Appropriateness of vancomycin use was evaluated with criteria established through IDSA guidelines. Vancomycin use was considered appropriate in serious infections due to beta-lactam resistant gram-positive organisms, treatment of infections in the setting of beta-lactam allergy, surgical prophylaxis in patients allergic to beta-lactam antibiotics and empiric treatment for serious infections such as septic shock, bacteremia and infective endocarditis, healthcare-associated pneumonia, osteomyelitis and septic arthritis and central nervous system infections. De-escalation of vancomycin after 72 hours was considered appropriate when used empirically. Any deviation from criteria was deemed inappropriate. Variables reviewed included age, gender, length of stay, mortality, intensive care unit (ICU) admission, and length of vancomycin use. Data is expressed as percentage for nominal variables and as mean with standard deviation for continuous variables. Age, gender, mortality and ICU admission were further analyzed by chi-square tests. Length of stay and vancomycin use days were analyzed using unpaired t-test. A P-value < 0.05 was considered significant for the study.
A total of 595 encounters of vancomycin use were included in the study. Overall, 38.2% of all patients were admitted to the ICU, and hospital mortality was 9.24%. Vancomycin use was shown to be inappropriate in 34.3% of all patient encounters. Slightly higher mortality was noted in the appropriate group, but it was not found to be statistically significant (10.74% in appropriate group vs. 6.37% in inappropriate vancomycin use group; p = 0.10). Mean length of stay in patients between the two groups was not found to be statistically significant (12.60 ± 18.23 days for appropriate group vs. 14.01 ± 21.64 days for inappropriate group; p = 0.40). Significantly higher ICU admission was found for the appropriate group (41.43% in appropriate group vs. 32.35% in the inappropriate group, p = 0.0001). The most common indication for appropriate use of vancomycin was for empiric treatment (47.6%), while surgical prophylaxis in the absence of beta-lactam allergy was the most common indication for the inappropriate vancomycin use group (41.7%).
The study reveals that there was inappropriate use in about one-third of all vancomycin use encounters. The study also found some outcomes such as ICU admission to be statistically significant between the two groups. The study identified common indications for inappropriate use to target further interventions.
Singh, Sehajvir; Prajapati, Avi; Van Schooneveld, Trevor; and Tiwari, Manish, "Appropriateness of Vancomycin Use and Associated Outcomes" (2022). Posters: 2022 Summer Undergraduate Research Program. 32.