This study evaluates
vancomycin prescribing patterns in a tertiary-care hospital, with high prevalence of methicillin-resistant Staphylococcus aureus, comparing with the guidelines proposed by the
Hospital Infection Control Practices Advisory Committee. The study was conducted in a 930-bed tertiary-care hospital, during 40 days (March 10 to April 30, 2003). Data were collected of all patients given
vancomycin, using a standardized chart-extraction form designed. Inappropriate use was subdivided in five categories: empiric
therapy without risk factors; continued empiric use for presumed
infections in patients whose cultures were negative for beta-lactam-resistant Gram-positive microorganisms; treatment of
infections caused by
beta-lactam-sensitive Gram-positive microorganisms, without
allergy history to
beta-lactam antimicrobials; treatment in response to a single blood culture positive for
coagulase-negative staphylococcus, if other blood cultures taken during the same time frame were negative; systemic or local prophylaxis for
infection or colonization of indwelling central or peripheral intravascular
catheters. Of 132 orders, 126 (95.4%) were considered to have been appropriate. Of these 126 prescriptions, 31 (24.6%) were administered for treatment of proven Gram-positive
infections (78.1% of those were MRSA), 1 (0.8%) for
beta-lactam allergy and 95 (75.4%) for empiric treatment of suspected Gram-positive
infections. The majority of the patients (88.6%) have used antimicrobial recently (3 months). The mean pre-treatment hospitalization period was 14 +/- 15 days. Of the 132 treatments, 105 (79.5%) were
nosocomial infections. In the institution analyzed, the
vancomycin use was considered conscientious. Reduction in use of
glycopeptide may be obtained by adaptations the CDC criteria, or by improvement of diagnostic criteria.