Evaluating vancomycin use at a pediatric hospital

New approaches and insights

Maureen K Bolon*, Alana D. Arnold, Henry A. Feldman, David H. Rehkopf, Emily F. Strong, Donald A. Goldmann, Sharon B. Wright

*Corresponding author for this work

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

OBJECTIVES: To characterize vancomycin use at a pediatric tertiary-care hospital, to discriminate between initial (≤ 72 hours) and prolonged (> 72 hours) inappropriate use, and to define patient characteristics associated with inappropriate use. DESIGN: Vancomycin courses were retrospectively reviewed using an algorithm modeled on HICPAC guidelines. Data were collected regarding patient demographics, comorbidities, other medication use, and nosocomial infections. The association between each variable and the outcome of inappropriate use was determined by longitudinal regression analysis. A multivariable model was constructed to assess risk factors for inappropriate initial and prolonged vancomycin use. SETTING: A pediatric tertiary-care medical center. PATIENTS: Children older than 1 year who received intravenous vancomycin from November 2000 to June 2001. RESULTS: Three hundred twenty-seven vancomycin courses administered to 260 patients were evaluated for appropriateness. Of initial courses, 114 (35%) were considered inappropriate. Of 143 prolonged courses, 103 (72%) were considered inappropriate. Multivariable risk factor analysis identified the following variables as significantly associated with inappropriate initial use: admission to the surgery service, having a malignancy, receipt of a stem cell transplant, and having received a prior inappropriate course of vancomycin. No variables were identified as significant risk factors for inappropriate prolonged use. CONCLUSIONS: Substantial inappropriate use of vancomycin was identified. Prolonged inappropriate use was a particular problem. This risk factor analysis suggests that interventions targeting patients admitted to certain services or receiving multiple courses of vancomycin could reduce inappropriate use.

Original languageEnglish (US)
Pages (from-to)47-55
Number of pages9
JournalInfection Control and Hospital Epidemiology
Volume26
Issue number1
DOIs
StatePublished - Jan 1 2005

Fingerprint

Pediatric Hospitals
Vancomycin
Tertiary Care Centers
Statistical Factor Analysis
Tertiary Healthcare
Cross Infection
Comorbidity
Stem Cells
Regression Analysis
Demography
Guidelines
Pediatrics
Transplants

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology

Cite this

Bolon, M. K., Arnold, A. D., Feldman, H. A., Rehkopf, D. H., Strong, E. F., Goldmann, D. A., & Wright, S. B. (2005). Evaluating vancomycin use at a pediatric hospital: New approaches and insights. Infection Control and Hospital Epidemiology, 26(1), 47-55. https://doi.org/10.1086/502486
Bolon, Maureen K ; Arnold, Alana D. ; Feldman, Henry A. ; Rehkopf, David H. ; Strong, Emily F. ; Goldmann, Donald A. ; Wright, Sharon B. / Evaluating vancomycin use at a pediatric hospital : New approaches and insights. In: Infection Control and Hospital Epidemiology. 2005 ; Vol. 26, No. 1. pp. 47-55.
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Bolon, MK, Arnold, AD, Feldman, HA, Rehkopf, DH, Strong, EF, Goldmann, DA & Wright, SB 2005, 'Evaluating vancomycin use at a pediatric hospital: New approaches and insights', Infection Control and Hospital Epidemiology, vol. 26, no. 1, pp. 47-55. https://doi.org/10.1086/502486

Evaluating vancomycin use at a pediatric hospital : New approaches and insights. / Bolon, Maureen K; Arnold, Alana D.; Feldman, Henry A.; Rehkopf, David H.; Strong, Emily F.; Goldmann, Donald A.; Wright, Sharon B.

In: Infection Control and Hospital Epidemiology, Vol. 26, No. 1, 01.01.2005, p. 47-55.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Evaluating vancomycin use at a pediatric hospital

T2 - New approaches and insights

AU - Bolon, Maureen K

AU - Arnold, Alana D.

AU - Feldman, Henry A.

AU - Rehkopf, David H.

AU - Strong, Emily F.

AU - Goldmann, Donald A.

AU - Wright, Sharon B.

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N2 - OBJECTIVES: To characterize vancomycin use at a pediatric tertiary-care hospital, to discriminate between initial (≤ 72 hours) and prolonged (> 72 hours) inappropriate use, and to define patient characteristics associated with inappropriate use. DESIGN: Vancomycin courses were retrospectively reviewed using an algorithm modeled on HICPAC guidelines. Data were collected regarding patient demographics, comorbidities, other medication use, and nosocomial infections. The association between each variable and the outcome of inappropriate use was determined by longitudinal regression analysis. A multivariable model was constructed to assess risk factors for inappropriate initial and prolonged vancomycin use. SETTING: A pediatric tertiary-care medical center. PATIENTS: Children older than 1 year who received intravenous vancomycin from November 2000 to June 2001. RESULTS: Three hundred twenty-seven vancomycin courses administered to 260 patients were evaluated for appropriateness. Of initial courses, 114 (35%) were considered inappropriate. Of 143 prolonged courses, 103 (72%) were considered inappropriate. Multivariable risk factor analysis identified the following variables as significantly associated with inappropriate initial use: admission to the surgery service, having a malignancy, receipt of a stem cell transplant, and having received a prior inappropriate course of vancomycin. No variables were identified as significant risk factors for inappropriate prolonged use. CONCLUSIONS: Substantial inappropriate use of vancomycin was identified. Prolonged inappropriate use was a particular problem. This risk factor analysis suggests that interventions targeting patients admitted to certain services or receiving multiple courses of vancomycin could reduce inappropriate use.

AB - OBJECTIVES: To characterize vancomycin use at a pediatric tertiary-care hospital, to discriminate between initial (≤ 72 hours) and prolonged (> 72 hours) inappropriate use, and to define patient characteristics associated with inappropriate use. DESIGN: Vancomycin courses were retrospectively reviewed using an algorithm modeled on HICPAC guidelines. Data were collected regarding patient demographics, comorbidities, other medication use, and nosocomial infections. The association between each variable and the outcome of inappropriate use was determined by longitudinal regression analysis. A multivariable model was constructed to assess risk factors for inappropriate initial and prolonged vancomycin use. SETTING: A pediatric tertiary-care medical center. PATIENTS: Children older than 1 year who received intravenous vancomycin from November 2000 to June 2001. RESULTS: Three hundred twenty-seven vancomycin courses administered to 260 patients were evaluated for appropriateness. Of initial courses, 114 (35%) were considered inappropriate. Of 143 prolonged courses, 103 (72%) were considered inappropriate. Multivariable risk factor analysis identified the following variables as significantly associated with inappropriate initial use: admission to the surgery service, having a malignancy, receipt of a stem cell transplant, and having received a prior inappropriate course of vancomycin. No variables were identified as significant risk factors for inappropriate prolonged use. CONCLUSIONS: Substantial inappropriate use of vancomycin was identified. Prolonged inappropriate use was a particular problem. This risk factor analysis suggests that interventions targeting patients admitted to certain services or receiving multiple courses of vancomycin could reduce inappropriate use.

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DO - 10.1086/502486

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