Effect of a Vancomycin Restriction Policy on Ordering Practices During an Outbreak of Vancomycin-Resistant Enterococcus faecium

doi:10.1001/archinte.1997.00440310098010

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Vol. 157 No. 10, 26 MAY 1997

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Effect of a Vancomycin Restriction Policy on Ordering Practices During an Outbreak of Vancomycin-Resistant Enterococcus faecium

Anne M. Anglim, MD, MS; Beth Klym, PharmD; Karin E. Byers, MD; W. Michael Scheld, MD; Barry M. Farr, MD, MSc

Arch Intern Med. 1997;157(10):1132-1136.

Abstract

Background
With the development of nosocomial pathogens that are resistantto multiple antimicrobial agents, reasonable restriction ofantibiotic use has become a priority.

Methods
During an outbreak of vancomycin-resistant enterococcal infections,an audit of vancomycin hydrochloride use was conducted duringOctober 3 through 21, 1994, and January 24 through February2, 1995. During these periods, all orders for vancomycin werereviewed by clinical pharmacists. Use was classified as eitherappropriate or inappropriate based on recommendations by theHospital Infection Control Practice Advisory Committee (HICPAC)of the Centers for Disease Control and Prevention, Atlanta,Ga. A policy restricting the use of vancomycin was adopted inNovember 1994.

Results
During the first audit in October 1994, 61% of vancomycin orderswere considered inappropriate according to HICPAC criteria.At the time of this audit, the first cases of an outbreak ofnosocomial vancomycin-resistant Enterococcus faecium had beendetected. The follow-up audit showed that 30% of vancomycinorders were inappropriate by HICPAC criteria (P<.001). Overalluse of vancomycin decreased by 50% and remained at this lowerlevel for the following year.

Conclusion
The institution of a vancomycin restriction policy was associatedwith a reduction of both inappropriate drug orders and totaluse.

Arch Intern Med. 1997;157:1132-1136

Author Affiliations

From the Departments of Internal Medicine (Drs Anglim, Byers, Scheld, and Farr) and Pharmacy (Dr Klym), University of Virginia Health Sciences Center, Charlottesville.

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