Vazin Afsaneh, Mahi Birjand Motahare, Darake Masoud
Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
Drug Healthc Patient Saf. 2018 Apr 5;10:21-26. doi: 10.2147/DHPS.S149451. eCollection 2018.
Vancomycin resistance in intensive care units (ICUs) accounts for significant morbidity and excess costs. The objective of the present study was to determine the appropriateness of vancomycin use in the various ICUs of Nemazee Hospital, Shiraz, Iran.
This prospective study was performed on 95 critically ill patients (48 males and 47 females) who were treated with vancomycin for at least 3 subsequent doses in 6 ICUs during 12 months. Required demographic, clinical, and paraclinical data were collected by a pharmacist. Fifteen indexes were considered for evaluation of vancomycin use.
Ventilator-associated hospital-acquired pneumonia (22.6%), sepsis (22.1%) and CNS infection (12.6%) were found to be the most important indications for vancomycin prescription. Vancomycin was prescribed empirically in 81% of patients. None of the patients received loading dose, and most of the patients received fixed dose. The rate of prolonged empiric antibiotic therapy was 68.5% in patients who received vancomycin. The mean score of vancomycin use in the ICUs of Nemazee Hospital was 7.1±0.6 out of 15, implying that the rate of vancomycin use was in accordance with the guideline proposed by the Department of Clinical Pharmacy of Nemazee Hospital based on Infectious Diseases Society of America by 47.3%.
Based on our results, the weakness in using vancomycin was related to not administering loading dose, the practice of prescribing fixed-dose vancomycin and prolonged duration of empiric therapy. Efforts to improve the pattern of vancomycin prescription and utilization in these ICUs should be undertaken.
重症监护病房（ICU）中的万古霉素耐药性导致了显著的发病率和额外费用。本研究的目的是确定伊朗设拉子内马齐医院各ICU中万古霉素使用的合理性。
这项前瞻性研究对95例危重症患者（48例男性和47例女性）进行，这些患者在12个月内在6个ICU中接受了至少3次后续剂量的万古霉素治疗。所需的人口统计学、临床和辅助临床数据由一名药剂师收集。考虑了15项指标来评估万古霉素的使用情况。
呼吸机相关性医院获得性肺炎（22.6%）、败血症（22.1%）和中枢神经系统感染（12.6%）被发现是万古霉素处方的最重要指征。81%的患者接受了经验性万古霉素治疗。没有患者接受负荷剂量，大多数患者接受固定剂量。接受万古霉素治疗的患者中经验性抗生素治疗延长的比例为68.5%。内马齐医院ICU中万古霉素使用的平均得分为7.1±0.6（满分15分），这意味着万古霉素的使用率符合内马齐医院临床药学部根据美国传染病学会提出的指南的47.3%。
根据我们的结果，万古霉素使用中的不足与未给予负荷剂量、开具固定剂量万古霉素的做法以及经验性治疗时间延长有关。应努力改善这些ICU中万古霉素的处方和使用模式。
