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Effectiveness of a Guideline to Reduce Vancomycin Use in the Neonatal Intensive Care Unit

Chiu, Chia-Hua MD*; Michelow, Ian C. MB BCH, DTM&H†‡; Cronin, Jonathan MD‡§; Ringer, Steven A. MD, PhD‡¶; Ferris, Timothy G. MD‡∥; Puopolo, Karen M. MD, PhD‡¶

The Pediatric Infectious Disease Journal: April 2011 - Volume 30 - Issue 4 - p 273-278
doi: 10.1097/INF.0b013e3182011d12
Original Studies

Background: The Centers for Disease Control and Prevention recommend hospitals develop guidelines for the appropriate use of vancomycin as part of comprehensive antimicrobial stewardship. The objective of this study was to evaluate the effectiveness and safety of a guideline to restrict vancomycin use in the neonatal intensive care unit (NICU).

Methods: A vancomycin use guideline was introduced in 2 tertiary care NICUs with low incidences of methicillin-resistant Staphylococcus aureus infections. We compared all infants >72 hours of age who were evaluated for late-onset infection before and after implementation of this guideline.

Results: Vancomycin start rates were reduced from 6.9 to 4.5 per 1000 patient-days (35% reduction; P = 0.01) at Brigham and Women's Hospital, and from 17 to 6.4 per 1000 patient-days (62% reduction; P < 0.0001) at Massachusetts General Hospital. The number of infants exposed to vancomycin decreased from 5.2 to 3.1 per 1000 patient-days (40% reduction; P = 0.008) at Brigham and Women's Hospital, and 10.8 to 5.5 per 1000 patient-days (49% reduction; P = 0.009) at Massachusetts General Hospital. Causes of infection, duration of bacteremia, and incidence of complications or deaths attributable to late-onset infection did not change significantly at either institution.

Conclusions: Implementation of a NICU vancomycin use guideline significantly reduced exposure of newborns to vancomycin without adversely affecting short-term patient safety. Further studies are required to evaluate the long-term effect of vancomycin restriction on NICU patient safety and microbial ecology, particularly among institutions with higher rates of methicillin-resistant Staphylococcus aureus infections.

From the *Division of Newborn Medicine, Children's Hospital, Boston, MA; †Division of Pediatric Infectious Diseases, Massachusetts General Hospital, Boston, MA; ‡Department of Medicine, Brigham and Women's Hospital, Boston, MA; §Neonatology and Newborn Medicine Unit, Massachusetts General Hospital, Boston, MA; ¶Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA; and ∥Department of Medicine, Massachusetts General Hospital, Boston, MA.

Accepted for publication October 11, 2010.

Chia-Hua Chiu is currently at Department of Pediatrics, Mount Sinai School of Medicine, New York, NY; and Division of Newborn Medicine, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373.

C.H.C. and I.C.M. contributed equally to the primary authorship of this manuscript.

Presented at the Pediatric Academic Societies Annual Meeting; May 2, 2009; Baltimore, MD.

Address for correspondence: Karen M. Puopolo, MD, PhD, Department of Newborn Medicine and Channing Laboratory, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail: kpuopolo@partners.org.

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© 2011 Lippincott Williams & Wilkins, Inc.