Morgan A S, Brennan P J, Fishman N O
University of Pennsylvania Medical Center, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Ann Pharmacother. 1997 Sep;31(9):970-3. doi: 10.1177/106002809703100902.
To review the appropriateness of vancomycin therapy, changes in vancomycin use, and the incidence of vancomycin-resistant Enterococcus (VRE) after implementation of a limited restriction policy requiring approval from the Infectious Diseases Approval service to continue vancomycin therapy beyond 72 hours.
A prospective chart review was conducted in April 1995. Pharmacy billing data and infection control data were compared before and after policy implementation.
A 725-bed university teaching institution.
All patients receiving vancomycin during April 1995.
Appropriateness of use was based on the Centers for Disease Control and Prevention (CDC) recommendations for prudent vancomycin use.
A total of 333 courses of vancomycin therapy were reviewed. Vancomycin use was appropriate in 219 (66%) courses. Of the 114 courses that did not meet the CDC guidelines, 76 (67%) were for empiric use, 35 (31%) were for prophylactic use, and 3 (3%) were for therapeutic use. Overall, the total number of grams used decreased 9%, grams per 1000 patient-days decreased by 10, and the total number of patients exposed to vancomycin decreased 0.5%. Several services had large decreases in vancomycin use. Vancomycin expenditures decreased by $15788 for the 7-month time period. The incidence of VRE remained unchanged, at 30% of all enterococcal isolates 2 years after policy implementation.
The limited restriction policy was effective in decreasing the total grams of vancomycin used. However, one-third of vancomycin therapy was inappropriate and the incidence of VRE was unchanged. A more stringent restriction policy could potentially increase appropriate use, further decrease the amount of vancomycin used, and decrease the incidence of VRE.
回顾万古霉素治疗的合理性、万古霉素使用情况的变化，以及在实施一项有限制政策（该政策要求超过72小时的万古霉素治疗需经传染病审批服务部门批准）后耐万古霉素肠球菌（VRE）的发生率。
1995年4月进行了一项前瞻性病历审查。比较了政策实施前后的药房计费数据和感染控制数据。
一家拥有725张床位的大学教学机构。
1995年4月期间所有接受万古霉素治疗的患者。
使用合理性依据疾病控制与预防中心（CDC）关于谨慎使用万古霉素的建议。
共审查了333个万古霉素治疗疗程。219个（66%）疗程的万古霉素使用是合理的。在114个不符合CDC指南的疗程中，76个（67%）用于经验性治疗，35个（31%）用于预防性治疗，3个（3%）用于治疗性治疗。总体而言，使用的总克数减少了9%，每1000患者日的克数减少了10，接受万古霉素治疗的患者总数减少了0.5%。几个科室的万古霉素使用量大幅下降。7个月期间万古霉素支出减少了15788美元。政策实施2年后，VRE的发生率保持不变，占所有肠球菌分离株的30%。
有限制政策在减少万古霉素的总使用克数方面是有效的。然而，三分之一的万古霉素治疗是不合理的，且VRE的发生率没有变化。更严格的限制政策可能会增加合理使用，进一步减少万古霉素的使用量，并降低VRE的发生率。
