Infection Control & Hospital Epidemiology (2018), 39, 989–990 doi:10.1017/ice.2018.123
Concise Communication
Rate of positive cultures necessitating definitive treatment in patients receiving empiric vancomycin therapy
C. Dustin Waters PharmD, BCPS(AQ-ID)1 and Joshua Caraccio PharmD, BCPS2 1Intermountain Healthcare McKay-Dee Hospital, Ogden, Utah and 2Intermountain Healthcare Utah Valley Hospital, Provo, Utah (Present affiliation, Vigilanz, Minneapolis, Minnesota [J.C.].)
Abstract
Vancomycin is a commonly prescribed empiric antibiotic used when methicillin-resistant Staphylococcus aureus (MRSA) infection is suspected. In this study, we aimed to determine the rate of culture-positive infection requiring vancomycin therapy. (Received 23 February 2018; accepted 25 April 2018; electronically published June 12, 2018)
Vancomycin is commonly used when methicillin-resistant Sta- phylococcus aureus (MRSA) infections are suspected. Despite the almost ubiquitous use of vancomycin in healthcare institutions, some data indicate that the prevalence of invasive MRSA infec- tions are decreasing.1 Despite declining rates of MRSA infection, vancomycin has been reported to be the most prevalent anti- microbial agent used in the inpatient setting.2 Due to its wide- spread use, data on the prevalence of infections requiring vancomycin for definitive therapy are needed. Vancomycin is often continued unnecessarily, despite the lack
of positive cultures. In one report, nearly 25% of vancomycin use was continued inappropriately, despite a lack of culture data suggesting that patients did not have an organism that would necessitate definitive therapy with vancomycin.3 Although mul- tiple studies have been conducted to evaluate inappropriate vancomycin use, few data are available to indicate the proportion of patients who receive vancomycin that need vancomycin for definitive therapy. With the knowledge that vancomycin is the most common parenteral drug used to treat infections in the inpatient setting, its use may not be warranted in most cases.2 The purpose of the current study was to determine the rate of culture- positive MRSA infection or other organism requiring vancomycin therapy compared with overall vancomycin use.
Methods
This retrospective, observational study was conducted within Inter- mountain Healthcare. All patients receiving empiric intravenous (IV) vancomycin between January 1, 2014, and March 31, 2014, were evaluated to determine the rate of positive cultures necessitating
Author for correspondence: C. DustinWaters, PharmD, BCPS(AQ-ID); 4403 Harrison
Blvd, Ogden, UT 84403. E-mail:
dustin.waters@imail.org PREVIOUS PRESENTATION. This article was presented in abstract form at the
American Society of Health-System Pharmacists Midyear Clinical Meeting, Las Vegas, Nevada, on December 6, 2016
Cite this article: Waters CD. (2018). Rate of positive cultures necessitating definitive
treatment in patients receiving empiric vancomycin therapy”. Infection Control & Hospital Epidemiology 2018, 39; 989–990. doi: 10.1017/ice.2018.123
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. Discussion
Vancomycin continues to be the most commonly used empiric antibiotic in the inpatient setting for suspected infections. Much of this use occurs in patients in whom MRSA is a suspected pathogen. However, the results of this study suggest that MRSA is
continued vancomycin therapy. Patients were excluded if they received oral vancomycin, if they were <18 years of age, or if they were admitted to the pediatric or orthopedic specialty hospitals within the health system. Patient-specific microbiologic results were evaluated via chart review to determine whether the isolated bacteria would warrant continued therapy with vancomycin. The primary outcomevariablewas
therateofpositiveculturesthat would
necessitate definitive vancomycin therapy. Conditions or isolated bacteria that were considered appropriate for continued vancomycin therapy included MRSA infection, infection with other bacteria for which vancomycin would be considered the drug of choice, and drug allergy for which vancomycin was a second-line option. The Insti- tutional Review Board of Intermountain Healthcare approved this study and granted a waiver of informed consent. The total number of patients requiring vancomycin was calculated as the percentage of the total number of patients who received vancomycin.
Results
A total of 1,662 patients met the inclusion criteria and were eval- uated to determine whether definitive therapy with vancomycin was warranted. Of the patients who received vancomycin, 186 (11.2%) had a positive culture for an organismthat wouldmake vancomycin appropriate as definitive therapy. Among all patients who received vancomycin, 140 (8.4%) had positive MRSA cultures. The most common sources of infection in culture-positive
patients were skin and soft-tissue infection (SSTI, 38%), followed by bacteremia (29%), and respiratory infection (19%). Other sources of culture positivity indicative of infection included bone and/or joint infections (7%), urinary tract infections (3.5%), and miscellaneous or other infections (3.5%).
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