161. Overuse of Vancomycin in a Neonatal Intensive Care Unit
Session: Poster Abstract Session: Antimicrobial Use in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • IDweek2013 final.pdf (231.1 kB)
  • Background:

    Antimicrobial stewardship is a major patient safety issue. One role of stewardship is to decrease the incidence of bacterial resistance by optimizing treatment of infectious pathogens. Vancomycin (Vanc) is one of the most frequently utilized antimicrobials, particularly in the neonatal intensive care unit (NICU). Use of Vanc is an independent risk factor for acquisition, infection and prevalence of Vanc resistant organisms.   The CDC has published guidelines for appropriate use of Vanc to prevent spread of Vanc resistance.  Little data are available regarding the appropriateness of antimicrobial use, particularly Vanc, in the NICU setting.


    Prospective observational study of Vanc utilization in the Children’s Memorial Hermann Hospital NICU, a 118 bed level IV NICU.   Vanc utilization for all infants >3 days old was collected from 10/1/2012 through 2/28/2013.  Culture data was concurrently collected for all patients receiving antibiotic therapy.  Vanc use was considered appropriate if used to treat infection due to targeted pathogens (MRSA, coagulase negative staphylococcus (CONS) or ampicillin resistant enterococci).  Prevalence and judiciousness of Vanc use was described.


    91 patients received antibiotics for 137 separate episodes over the 5 month period.  Vanc was routinely utilized as empiric therapy of clinical sepsis and necrotizing enterocolitis (NEC).  82/91 (90%) of patients received Vanc for 115 episodes.  45/82 (55%) patients received Vanc for > 2 days, representing 59/115 (51%) of episodes. There were a total of 557 days of Vanc administration, representing 0.06 days/1,000 patient days. Of 59 episodes when Vanc was administered for > 2 days, only 8 (14%) had a positive clinical culture for which Vanc was indicated (4 for > 2 blood cultures positive for CONS, 3 for MRSA infections, 1 for other infection due to CONS).


    Vanc is inappropriately utilized in >85% of antibiotic administration episodes in our NICU. Despite culture data demonstrating low prevalence of MRSA and CONS infections, it is still utilized as the first line agent for suspicion of sepsis as well as NEC.  In addition, it is often continued >2 days despite negative cultures.  Interventions to decrease empiric, unnecessary Vanc usage in the NICU should be developed.

    Galit Holzmann-Pazgal, MD1, Amir Khan, M.D.1, Christine Domonoske, PharmD2 and Eric Eichenwald, MD1, (1)University of Texas Medical School, Houston, TX, (2)Children's Memorial Hermann Hospital, Houston, TX


    G. Holzmann-Pazgal, University of Texas: Grant Investigator, Grant recipient

    A. Khan, University of Texas: Grant Investigator, Grant recipient

    C. Domonoske, None

    E. Eichenwald, University of Texas: Grant Investigator, Grant recipient

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