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Volume 11, Number 10—October 2005

Vancomycin and Home Health Care

Thomas G. Fraser*1, Valentina Stosor*, Qiong Wang†, Anne Allen‡, and Teresa R. Zembower*Comments to Author 
Author affiliations: *Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; †University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA; ‡Northwestern Memorial Hospital, Chicago, Illinois, USA

Main Article

Table 1

HICPAC guidelines for prudent use of parenteral vancomycin*

1) Situations in which use of vancomycin is appropriate
A) Treatment of serious infections caused by β-lactam-resistant, gram-positive organisms
B) Treatment of infections caused by gram-positive microorganisms in patients with serious allergies to β-lactam antimicrobial agents
C) Prophylaxis, as recommended by the American Heart Association, after certain procedures in patients at high risk for endocarditis
D) Prophylaxis for major surgical procedures involving implantation of prosthetic materials or devices at institutions that have a high rate of infections caused by MRSA or methicillin-resistant Staphylococcus epidermidis
2) Situations in which use of vancomycin should be discouraged
A) Routine surgical prophylaxis, unless patient has life-threatening allergy to β-lactam antimicrobial drugs
B) Empiric antimicrobial therapy for febrile neutropenic patient, unless evidence indicates patient has infection caused by gram-positive microorganisms and prevalence of MRSA infections in hospital is substantial
C) Treatment in response to single blood culture positive for coagulase-negative staphylococci, if other blood cultures taken during same timeframe are negative
D) Continued empiric use for presumed infections in patients whose cultures are negative for β-lactam-resistant gram-positive microorganisms
E) Systemic or local (e.g., antimicrobial drug lock therapy)† prophylaxis for infection or colonization of intravascular catheters
F) Eradication of MRSA colonization
G) Routine prophylaxis for very-low-birthweight infants
H) Routine prophylaxis for dialysis patients
I) Treatment (chosen for dosing convenience) of infections caused by β-lactam-sensitive, gram-positive microorganisms in patients with renal failure

*Summarized from reference 7. HICPAC, Hospital Infection Control Practices Advisory Committee; MRSA, methicillin-resistant Staphylococcus aureus.
†Instilling a high concentration of antimicrobial drug to which organism is susceptible into lumen of catheter in attempt to sterilize it.

Main Article

  1. Wilhelm  MP, Estes  L. Symposium on antimicrobial agents—Part XII. Vancomycin. Mayo Clin Proc. 1999;74:92835. DOIPubMedGoogle Scholar
  2. Ena  J, Dick  RW, Jones  RN, Wenzel  RP. The epidemiology of intravenous vancomycin usage in a university hospital. JAMA. 1993;269:598602. DOIPubMedGoogle Scholar
  3. Fridkin  SK, Edwards  JR, Pichette  SC, Pryor  ER, McGowan  JE Jr, Tenover  FC, Determinants of vancomycin use in adult intensive care units in 41 United States hospitals. Clin Infect Dis. 1999;28:111925. DOIPubMedGoogle Scholar
  4. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989–1993. MMWR Morb Mortal Wkly Rep. 1993;42:5979.PubMedGoogle Scholar
  5. Centers for Disease Control and Prevention. Staphylococcus aureus resistant to vancomycin¾United States, 2002. MMWR Morb Mortal Wkly Rep. 2002;51:5657.PubMedGoogle Scholar
  6. Chang  S, Sievert  DM, Hageman  JC, Boulton  ML, Tenover  FC, Downes  FP, Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. N Engl J Med. 2003;348:13427. DOIPubMedGoogle Scholar
  7. Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep. 1995;44:113.PubMedGoogle Scholar
  8. Shlaes  DM, Gerding  DN, John  JF Jr, Craig  WA, Bornstein  DL, Duncan  RA, Society for Healthcare Epidemiology of America and Infectious Disease Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis. 1997;18:27591.
  9. Jarvis  WR. Preventing the emergence of multidrug-resistant microorganisms through antimicrobial use controls: the complexity of the problem. Infect Control Hosp Epidemiol. 1996;17:4905. DOIPubMedGoogle Scholar
  10. Gould  IM. A review of the role of antibiotic policies in the control of antibiotic resistance. J Antimicrob Chemother. 1999;43:45965. DOIPubMedGoogle Scholar
  11. Hamilton  CD, Drew  R, Janning  S, Latour  JK, Hayward  S. Excessive use of vancomycin: a successful intervention strategy at an academic medical center. Infect Control Hosp Epidemiol. 2000;21:425. DOIPubMedGoogle Scholar
  12. Singer  MV, Haft  R, Barlam  T, Aronson  M, Shafer  A, Sands  KE. Vancomycin control measures at a tertiary-care hospital: impact of interventions on volume and patterns of use. Infect Control Hosp Epidemiol. 1998;19:24853. DOIPubMedGoogle Scholar
  13. Doern  GV, Heilmann  KP, Huynh  HK, Rhomberg  PR, Coffman  SL, Brueggemann  AB. Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in the United States during 1999–2000, including a comparison of resistance rate since 1994–1995. Antimicrob Agents Chemother. 2001;45:17219. DOIPubMedGoogle Scholar
  14. Salgado  CD, Farr  BM, Calfee  DP. Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clin Infect Dis. 2003;36:1319. DOIPubMedGoogle Scholar
  15. Tice  AD, Rehm  SJ, Dalovisio  JR, Bradley  JS, Martinelli  LP, Graham  DR, Practice guidelines for outpatient parenteral antimicrobial therapy. Clin Infect Dis. 2004;38:165172. DOIPubMedGoogle Scholar
  16. Charlson  ME, Pompei  P, Ales  KL, MacKenzie  CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:37383. DOIPubMedGoogle Scholar
  17. Deyo  RA, Cherkin  DC, Ciol  MA. Adapting a clinical comorbidity index for use with ICD-9 CM administrative databases. J Clin Epidemiol. 1992;6:6139. DOIPubMedGoogle Scholar
  18. Evans  ME, Kortas  KJ. Vancomycin use in a university medical center: comparison with Hospital Infection Control Practices Advisory Committee guidelines. Infect Control Hosp Epidemiol. 1996;17:3569. DOIPubMedGoogle Scholar
  19. Watanakunakorn  C. Prescribing pattern of vancomycin in a community teaching hospital with low prevalence of vancomycin resistant enterococci. Infect Control Hosp Epidemiol. 1997;18:7679. DOIPubMedGoogle Scholar
  20. Roghmann  MC, Perdue  BD, Polish  L. Vancomycin use in a hospital with vancomycin restriction. Infect Control Hosp Epidemiol. 1999;20:603. DOIPubMedGoogle Scholar
  21. Lipsky  BA, Baker  CA, McDonald  LL, Suzuki  NT. Improving the appropriateness of vancomycin use by sequential interventions. Am J Infect Control. 1999;27:8491. DOIPubMedGoogle Scholar
  22. Kwan  T, Lin  F, Ngai  B, Loeb  M. Vancomycin use in 2 Ontario tertiary care hospitals: a survey. Clin Invest Med. 1999;22:25664.PubMedGoogle Scholar
  23. Jarvis  WR. Epidemiology, appropriateness, and cost of vancomycin use. Clin Infect Dis. 1998;26:12003. DOIPubMedGoogle Scholar
  24. Sinkowitz  RL, Keyserling  H, Walker  TJ, Holland  J, Jarvis  WR. Epidemiology of vancomycin usage at a children's hospital, 1993 through 1995. Pediatr Infect Dis J. 1997;16:4859. DOIPubMedGoogle Scholar
  25. Paskovaty  A, Pflomm  JM, Myke  N, Seo  SK. A multidisciplinary approach to antimicrobial stewardship: evolution into the 21st century. Int J Antimicrob Agents. 2005;25:110. DOIPubMedGoogle Scholar
  26. Classen  DC, Burke  JP, Wenzel  RP. Infectious diseases consultation: impact on outcomes for hospitalized patients and results of a preliminary study. Clin Infect Dis. 1997;24:46870. DOIPubMedGoogle Scholar
  27. Byl  B, Clevenbergh  P, Jacobs  F, Struelens  MJ, Zech  F, Kentos  A, Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis. 1999;29:606. DOIPubMedGoogle Scholar
  28. Lee  CE, Zembower  TR, Fotis  MA, Postelnick  MJ, Greenberger  PA, Peterson  LR, The incidence of antimicrobial allergies in hospitalized patients: implications regarding prescribing patterns and emerging bacterial resistance. Arch Intern Med. 2000;160:281922. DOIPubMedGoogle Scholar
  29. Tice  AD, Hoaglund  PA, Nolet  B, McKinnon  PS, Mozaffari  E. Cost perspectives for outpatient intravenous antimicrobial therapy. Pharmacotherapy. 2002;22:63S70S. DOIPubMedGoogle Scholar

Main Article

1Current affiliation: Cleveland Clinic Foundation, Cleveland, Ohio, USA

Page created: February 22, 2012
Page updated: February 22, 2012
Page reviewed: February 22, 2012
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