BACKGROUND: In response to vancomycin-resistant bacteria, particularly vancomycin-resistant enterococci (VRE), measures have been recommended to improve on the appropriate use of vancomycin. METHODS: Intervention 1 consisted of an automatic 72-hour vancomycin stop order; Intervention 2, a standardized procedure for sampling of blood cultures; and Intervention 3, an interdisciplinary critical care team. RESULTS: After Intervention 1, inappropriate use decreased, particularly in treatment of febrile neutropenia and undocumented gram-positive infections. After Intervention 2, the baseline rate of inappropriately drawn blood cultures (IDBCs) was unchanged, and use in patients with IDBCs was comparable during both periods. Before Intervention 3, 38/55 orders continuing > 72 hours were considered inappropriate versus 24/53 (p < .025) after. After the interventions, hospitalwide vancomycin use was reduced. Yet the overall rate of VRE infection initially decreased but then increased once again over time. DISCUSSION: Despite substantial reduction in hospitalwide vancomycin use, the impact on the overall rate of VRE was inconsistent and ward dependent.
BACKGROUND: In response to vancomycin-resistant bacteria, particularly vancomycin-resistant enterococci (VRE), measures have been recommended to improve on the appropriate use of vancomycin. METHODS: Intervention 1 consisted of an automatic 72-hour vancomycin stop order; Intervention 2, a standardized procedure for sampling of blood cultures; and Intervention 3, an interdisciplinary critical care team. RESULTS: After Intervention 1, inappropriate use decreased, particularly in treatment of febrile neutropenia and undocumented gram-positive infections. After Intervention 2, the baseline rate of inappropriately drawn blood cultures (IDBCs) was unchanged, and use in patients with IDBCs was comparable during both periods. Before Intervention 3, 38/55 orders continuing > 72 hours were considered inappropriate versus 24/53 (p < .025) after. After the interventions, hospitalwide vancomycin use was reduced. Yet the overall rate of VRE infection initially decreased but then increased once again over time. DISCUSSION: Despite substantial reduction in hospitalwide vancomycin use, the impact on the overall rate of VRE was inconsistent and ward dependent.
Authors: Tamar F Barlam; Sara E Cosgrove; Lilian M Abbo; Conan MacDougall; Audrey N Schuetz; Edward J Septimus; Arjun Srinivasan; Timothy H Dellit; Yngve T Falck-Ytter; Neil O Fishman; Cindy W Hamilton; Timothy C Jenkins; Pamela A Lipsett; Preeti N Malani; Larissa S May; Gregory J Moran; Melinda M Neuhauser; Jason G Newland; Christopher A Ohl; Matthew H Samore; Susan K Seo; Kavita K Trivedi Journal: Clin Infect Dis Date: 2016-04-13 Impact factor: 9.079
Authors: Pyoeng Gyun Choe; Hei Lim Koo; Doran Yoon; Ji Yun Bae; Eunyoung Lee; Joo-Hee Hwang; Kyoung-Ho Song; Wan Beom Park; Ji Hwan Bang; Eu Suk Kim; Hong Bin Kim; Sang Won Park; Myoung-Don Oh; Nam Joong Kim Journal: BMC Infect Dis Date: 2018-04-16 Impact factor: 3.090