Division of Infectious Diseases, Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Pediatr Infect Dis J. 2010 Aug;29(8):707-11. doi: 10.1097/INF.0b013e3181d683f8.
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.
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.
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.
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.
耐革兰阳性球菌感染率的增加导致万古霉素的使用增加。我们评估了在一家儿科三级保健教学医院实施抗菌药物管理计划对万古霉素使用密度的影响。
抗菌药物管理计划于 2004 年 4 月 1 日实施。使用集成的计算机信息系统将万古霉素使用的适应症纳入强制性字段。感染病药剂师每周一至周五审查万古霉素处方、剂量、患者人口统计学和微生物学数据的自动报告。与儿科传染病医生讨论干预措施，并向临床医生提供实时反馈。通过测量每 1000 名患者天给予的剂量数来评估万古霉素的使用密度。
尽管金黄色葡萄球菌感染患者的比例增加，但万古霉素的使用密度随着时间的推移逐渐下降，从每 1000 名患者天 378 剂降至每 1000 名患者天 255 剂，且与其他具有相似抗菌活性的抗生素的使用增加无关。在给予的万古霉素剂量中，有 28%选择了非批准的万古霉素适应症。在实施该计划期间进行的 317 次抗菌药物管理计划干预中，190 次被确认为万古霉素处方错误，最常见的是万古霉素剂量和过早停药。该计划实施后，万古霉素处方错误的发生率下降。
使用实时评估和反馈医生以及优化临床信息系统实施综合抗菌药物管理计划，减少了万古霉素的使用和万古霉素的处方错误，提高了我们机构住院儿童的护理质量和安全性。
