Junior Moacyr S, Correa Luci, Marra Alexandre R, Camargo Luis F A, Pereira Carlos A P
Department of Infectious Disease, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
BMC Infect Dis. 2007 Aug 1;7:88. doi: 10.1186/1471-2334-7-88.
Vancomycin use is considered inappropriate in most hospitals. A particular concern is the recent emergence of S. aureus with decreased susceptibility to vancomycin, making it important to reduce overall exposure to vancomycin to minimize the incidence of VRE (vancomycin-resistant enterococci). The aim of this work was to analyze the use of vancomycin and the risk factors associated with inappropriate treatment.
A prospective survey was conducted on all patients receiving vancomycin between 1st March 2002 and 30th September 2002 in a university-school hospital. Appropriateness of vancomycin use was assessed, according to the criteria established by the Centers for Disease Control and Prevention (CDC), at two time points: first, at the beginning of therapy, and second, continuing after 72 hours.
A total of 557 patients received vancomycin. Three hundred seventy-four (67.1%) were under 60 years old, 374 (67.1%) had prolonged stays (>two weeks) in hospital, and 455 (81.7%) were in the intensive care unit (ICU). Two hundred sixty-three patients (47.2%) had some invasive device. In 324 (58.2%) patients the duration of vancomycin treatment was up to two weeks. Vancomycin was inappropriately used in 65.7% during the first 24 hours and in 67% at the 72 hours point according to CDC criteria 4. The inappropriateness of vancomycin use during the first 24 hours was related to: patients aged less than 60 (OR 1.7; CI 95% 1.1-2.5), non-ICU patients (OR 1.5; CI 95% 1.0-2.4) and patients without neutropenia (OR 7.5; CI 95% 2.4-22.7). At 72 hours, the inappropriateness of vancomycin use was related to: patients aged less than 60 (OR 1.5; CI 95% 1.0-2.3), non-ICU patients (OR 1.7; CI 95% 1.1-2.7) and patients without neutropenia (OR 8.0; CI 95% 2.6-24.3).
Vancomycin was abused. Patients aged less than 60, non-ICU patients and those who did not present neutropenia were the principal groups at risk of inappropriate use.
在大多数医院，万古霉素的使用被认为是不恰当的。一个特别令人担忧的问题是，最近出现了对万古霉素敏感性降低的金黄色葡萄球菌，因此减少万古霉素的总体暴露量以尽量降低耐万古霉素肠球菌（VRE）的发生率非常重要。这项研究的目的是分析万古霉素的使用情况以及与不恰当治疗相关的风险因素。
对一所大学附属医院在2002年3月1日至2002年9月30日期间接受万古霉素治疗的所有患者进行了一项前瞻性调查。根据美国疾病控制与预防中心（CDC）制定的标准，在两个时间点评估万古霉素使用的恰当性：首先是在治疗开始时，其次是在72小时后继续评估。
共有557名患者接受了万古霉素治疗。其中374名（67.1%）年龄在60岁以下，374名（67.1%）住院时间延长（超过两周），455名（81.7%）在重症监护病房（ICU）。263名患者（47.2%）有一些侵入性装置。324名（58.2%）患者的万古霉素治疗持续时间长达两周。根据CDC标准4，在治疗的最初24小时内，65.7%的万古霉素使用不恰当，在72小时时这一比例为67%。在最初24小时内万古霉素使用不恰当与以下因素有关：年龄小于60岁的患者（比值比1.7；95%置信区间1.1 - 2.5）、非ICU患者（比值比1.5；95%置信区间1.0 - 2.4）以及无中性粒细胞减少的患者（比值比7.5；95%置信区间2.4 - 22.7）。在72小时时，万古霉素使用不恰当与以下因素有关：年龄小于60岁的患者（比值比1.5；95%置信区间1.0 - 2.3）、非ICU患者（比值比1.7；95%置信区间1.1 - 2.7）以及无中性粒细胞减少的患者（比值比8.0；95%置信区间2.6 - 24.3）。
万古霉素存在滥用情况。年龄小于60岁的患者、非ICU患者以及没有出现中性粒细胞减少的患者是不恰当使用万古霉素的主要风险群体。
