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Vancomycin frequently misused in neonatal ICU

SAN FRANCISCO — More than 85% of the instances of vancomycin administration in a neonatal ICU were inappropriate, according to prospective study results presented at ID Week 2013.

The study included children aged at least 3 days admitted to the neonatal ICU at Children’s Memorial Hermann Hospital in Houston during a 5-month period from 2012 to 2013.

Appropriate use of vancomycin included treatment for methicillin-resistant Staphylococcus aureus, coagulase-negative staphylococci or ampicillin-resistant enterococci.

Researchers observed 137 administrations of antibiotics to 91 patients. Of them, 82 (90%) received vancomycin, for a total of 115 cases.

Of the 82 patients who received vancomycin, 45 (55%) received it for more than 2 days, accounting for 59 (51%) of the cases. Vancomycin was administered for a total of 557 days, equating to 0.6 days/1,000 patient-days.

However, only eight (14%) of these 59 cases were positive for MRSA (n=3), coagulase-negative staphylococcus (n=4) or an infection related to coagulase-negative staphylococci (n=1).

Vancomycin was frequently used in the treatment of clinical sepsis and necrotizing enterocolitis as empiric therapy, the researchers noted.

“Vancomycin is inappropriately utilized in more than 85% of antibiotic administration episodes in our neonatal ICU,” researchers wrote. “Despite culture data demonstrating low prevalence of MRSA and coagulase-negative staphylococcal infections, it is still utilized as the first-line agent for suspicion of sepsis as well as necrotizing enterocolitis. Interventions to decrease empiric, unnecessary vancomycin usage in the neonatal ICU should be developed.”

For more information:

Holzmann-Pazgal G. Abstract #161. Presented at: ID Week 2013; Oct. 2-6, 2013; San Francisco.

Disclosure: Some of the researchers report research funding from the University of Texas.