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Article: Curtailing unnecessary vancomycin usage in a hospital with high rates of methicillin resistant Staphylococcus aureus infections

TitleCurtailing unnecessary vancomycin usage in a hospital with high rates of methicillin resistant Staphylococcus aureus infections
Authors
KeywordsImmediate concurrent feedback
Implementing guidelines
Methicillin resistant Staphylococcus aureus (MRSA)
Vancomycin
Issue Date2001
PublisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCP
Citation
British Journal of Clinical Pharmacology, 2001, v. 52 n. 4, p. 427-432 How to Cite?
AbstractAIMS: To implement and monitor the effectiveness of a strategy to curb unnecessary use of vancomycin and teicoplanin for inpatients in a teaching hospital/tertiary referral centre where 33% of S. aureus isolates (72% from ICU patients) were methicillin resistant. METHODS: A sample of 182 vancomycin/teicoplanin inpatient prescriptions surveyed, revealed that only 31 (17%) conformed with Centre for Disease Control (CDC) guidelines. Following education (ward-rounds, bulletins) on appropriate CDC based guidelines for prescribing glycopeptides directed at relevant clinicians, 'Immediate Concurrent Feedback' (ICF) was gradually deployed throughout the hospital. This entailed review of respective inpatient records on the next working day. If the indication was deemed not to conform with our guidelines, the prescriber was issued a memo (copied to the supervising doctor). Each memo detailed the 'errant' incident, listed appropriate indications and explicitly advised desisting from such prescribing and suggested alternative therapy if necessary. Corresponding glycopeptide usage data for our hospital and others in Hong Kong were retrieved and analysed as were samples of records of our inpatients with staphylococcal septicaemia (pre and during ICF). RESULTS: Compared with baseline values, during 2 years of ICF, inpatient prescribing of vancomycin and teicoplanin deemed to conform increased to 71% (773/1086); difference 54% (P < 0.0001, 95% CIs 47-62%). Corresponding average monthly usage (DDDs/1000 admissions) decreased from 76 (pre-ICF) to 45; mean difference 31 (P < 0.0001, 95% CIs 24, 38). Mortality from staphylococcal bacteraemia remained unchanged. No comparable changes in glycopeptide usage ensued in comparator hospitals. CONCLUSIONS: ICF can be used safely to curb irrational overuse of vancomycin and teicoplanin in a hospital with high methicillin resistant S. aureus infection rates.
Persistent Identifierhttp://hdl.handle.net/10722/49113
ISSN
2015 Impact Factor: 3.83
2015 SCImago Journal Rankings: 1.486
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorKumana, CRen_HK
dc.contributor.authorChing, PTYen_HK
dc.contributor.authorKong, Yen_HK
dc.contributor.authorMa, ECWen_HK
dc.contributor.authorKou, Men_HK
dc.contributor.authorLee, RAen_HK
dc.contributor.authorCheng, VCCen_HK
dc.contributor.authorChiu, SSen_HK
dc.contributor.authorSeto, WHen_HK
dc.date.accessioned2008-06-12T06:34:42Z-
dc.date.available2008-06-12T06:34:42Z-
dc.date.issued2001en_HK
dc.identifier.citationBritish Journal of Clinical Pharmacology, 2001, v. 52 n. 4, p. 427-432en_HK
dc.identifier.issn0306-5251en_HK
dc.identifier.urihttp://hdl.handle.net/10722/49113-
dc.description.abstractAIMS: To implement and monitor the effectiveness of a strategy to curb unnecessary use of vancomycin and teicoplanin for inpatients in a teaching hospital/tertiary referral centre where 33% of S. aureus isolates (72% from ICU patients) were methicillin resistant. METHODS: A sample of 182 vancomycin/teicoplanin inpatient prescriptions surveyed, revealed that only 31 (17%) conformed with Centre for Disease Control (CDC) guidelines. Following education (ward-rounds, bulletins) on appropriate CDC based guidelines for prescribing glycopeptides directed at relevant clinicians, 'Immediate Concurrent Feedback' (ICF) was gradually deployed throughout the hospital. This entailed review of respective inpatient records on the next working day. If the indication was deemed not to conform with our guidelines, the prescriber was issued a memo (copied to the supervising doctor). Each memo detailed the 'errant' incident, listed appropriate indications and explicitly advised desisting from such prescribing and suggested alternative therapy if necessary. Corresponding glycopeptide usage data for our hospital and others in Hong Kong were retrieved and analysed as were samples of records of our inpatients with staphylococcal septicaemia (pre and during ICF). RESULTS: Compared with baseline values, during 2 years of ICF, inpatient prescribing of vancomycin and teicoplanin deemed to conform increased to 71% (773/1086); difference 54% (P < 0.0001, 95% CIs 47-62%). Corresponding average monthly usage (DDDs/1000 admissions) decreased from 76 (pre-ICF) to 45; mean difference 31 (P < 0.0001, 95% CIs 24, 38). Mortality from staphylococcal bacteraemia remained unchanged. No comparable changes in glycopeptide usage ensued in comparator hospitals. CONCLUSIONS: ICF can be used safely to curb irrational overuse of vancomycin and teicoplanin in a hospital with high methicillin resistant S. aureus infection rates.en_HK
dc.format.extent388 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCPen_HK
dc.rightsBritish Journal of Clinical Pharmacology. Copyright © Blackwell Publishing Ltd.en_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsThe definitive version is available at www.blackwell-synergy.comen_HK
dc.rightsBritish Journal of Clinical Pharmacology. Copyright © Blackwell Publishing Ltd.-
dc.subjectImmediate concurrent feedbacken_HK
dc.subjectImplementing guidelinesen_HK
dc.subjectMethicillin resistant Staphylococcus aureus (MRSA)en_HK
dc.subjectVancomycinen_HK
dc.titleCurtailing unnecessary vancomycin usage in a hospital with high rates of methicillin resistant Staphylococcus aureus infectionsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0306-5251&volume=52&issue=4&spage=427&epage=432&date=2001&atitle=Curtailing+unnecessary+vancomycin+usage+in+a+hospital+with+high+rates+of+methicillin+resistant+Staphylococcus+aureus+infectionsen_HK
dc.identifier.emailKumana, CR: hrmekcr@hku.hken_HK
dc.identifier.emailKou, M: mabkou@hkucc.hku.hken_HK
dc.identifier.emailLee, RA: ralee@hkucc.hku.hken_HK
dc.identifier.emailCheng, VCC: vcccheng@hkucc.hku.hken_HK
dc.identifier.emailChiu, SS: ssschiu@hkucc.hku.hken_HK
dc.identifier.emailSeto, WH: whseto@hkucc.hku.hken_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1046/j.0306-5251.2001.01455.xen_HK
dc.identifier.pmid11678786-
dc.identifier.pmcidPMC2014574en_HK
dc.identifier.scopuseid_2-s2.0-0034792586-
dc.identifier.hkuros66075-
dc.identifier.hkuros65040-
dc.identifier.isiWOS:000171286400010-

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