Impact of Antimicrobial Stewardship Program on Vancomycin Use in a Pediatric Teaching Hospital

Background: Increasing rates of resistant gram-positive coccal infections led to an increased use of vancomycin. We evaluated the impact of implementing an Antimicrobial Stewardship Program on density of vancomycin use at a pediatric tertiary-care teaching hospital. Methods: An Antimicrobial Stewardship Program was implemented April 1, 2004. Indications for vancomycin use were incorporated as mandatory fields using the integrated computerized information system. An automated report of vancomycin prescriptions, doses, patient demographics, and microbiology data was reviewed by an infectious disease pharmacist Monday through Friday. Interventions were discussed with a pediatric infectious disease physician and real-time feedback provided to clinicians. Density of vancomycin use was evaluated by measuring the number of doses administered/1000 patient-days. Results: Density of vancomycin use declined overtime from 378 doses administered/1000 patient-days to 255 doses administered/1000 patient-days despite increasing rates of Staphylococcus aureus infected patients, and was not associated with increased use of other antibiotics with similar antimicrobial activity. Nonapproved vancomycin indications were selected in 28% of vancomycin doses administered. Of the 317 Antimicrobial Stewardship Program interventions performed, 190 qualified as vancomycin prescription errors, most commonly, vancomycin dosing and premature stop. After the implementation of the program, the rate of vancomycin prescription errors decreased. Conclusions: Implementation of an integrated Antimicrobial Stewardship Program using real-time evaluation and feedback to physicians, and optimization of the clinical informatics system, reduced vancomycin utilization and vancomycin prescribing errors, improving the quality of care and safety of hospitalized children in our institution.