October 4, 2013
SAN FRANCISCO — More than 85% of the instances of vancomycin administration in a neonatal ICU were inappropriate, according to prospective study results presented at ID Week 2013.
The study included children aged at least 3 days admitted to the neonatal ICU at Children’s Memorial Hermann Hospital in Houston during a 5-month period from 2012 to 2013.
Appropriate use of vancomycin included treatment for methicillin-resistant Staphylococcus aureus, coagulase-negativestaphylococci or ampicillin-resistant enterococci.
Researchers observed 137 administrations of antibiotics to 91 patients. Of them, 82 (90%) received vancomycin, for a total of 115 cases.
Of the 82 patients who received vancomycin, 45 (55%) received it for more than 2 days, accounting for 59 (51%) of the cases. Vancomycin was administered for a total of 557 days, equating to 0.6 days/1,000 patient-days.
However, only eight (14%) of these 59 cases were positive for MRSA (n=3), coagulase-negative staphylococcus (n=4) or an infection related to coagulase-negative staphylococci (n=1).
Vancomycin was frequently used in the treatment of clinical sepsis and necrotizing enterocolitis as empiric therapy, the researchers noted.
“Vancomycin is inappropriately utilized in more than 85% of antibiotic administration episodes in our neonatal ICU,” researchers wrote. “Despite culture data demonstrating low prevalence of MRSA and coagulase-negativestaphylococcal infections, it is still utilized as the first-line agent for suspicion of sepsis as well as necrotizing enterocolitis. Interventions to decrease empiric, unnecessary vancomycin usage in the neonatal ICU should be developed.”