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Vancomycin guideline effective in neonatal ICUs
Chiu CH. Pediatric Infect Dis J. 2011;30:273-278.
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A guideline for using vancomycin in a neonatal intensive care unit significantly reduced use in the newborn setting without negatively affecting patient safety, according to a recent study published online.
Chia-Hua Chiu, MD, of the Children’s Hospital in Boston, and colleagues introduced the vancomycin use guideline in two tertiary care neonatal ICUs, Brigham and Women’s Hospital and Massachusetts General, both of which had low methicillin-resistant Staphylococcus aureus infection rates. The researchers then compared all infants for late-onset infection with rates before guideline implementation.
Chiu and colleagues said there was a 35% decrease in vancomycin use, from 6.9 to 4.5 per 1,000 patient-days, at Brigham and Women’s Hospital and a 62% decrease, from 17 to 6.4 per 1,000 patient-days, at Massachusetts General Hospital. The researchers estimated about a 40% to 50% decrease per 1,000 patient-days in the number of babies who were exposed to vancomycin in both hospitals.
The researchers said duration of bacteremia, causes of infection, and morbidity and mortality attributable to late-onset infection did not change significantly at either institution, but it is important to emphasize that both hospitals had low MRSA rates.
The researchers said there were some study limitations; specifically, a relatively short postimplementation period of about a year, and longer-term follow-up data will be needed to assess the guideline’s true effect.
“A 10-point plan to reduce antibiotic resistance, specifically in neonatal units, was proposed in 2006, including a recommendation to use narrow-spectrum antibiotics for empiric treatment of suspected infection until culture results mandate otherwise,” the researchers wrote. “Despite these recommendations from national organizations, vancomycin remains one of the most frequently used antibiotics in United States [neonatal] ICUs.”
These guidelines offer an option to reduce this use, the researchers said.
Disclosure: The researchers report no relevant financial disclosures.
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