Vancomycin Overuse in Siriraj Hospital
Pinyo Rattanaumpawan MD*, Visanu Thamlikitkul MD*, Kulkanya Chokepaibulkit MD**, Darin Lohsiriwat MD***, Nalinee Aswapokee MD*
Affiliation : * Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University ** Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University *** Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
Objective : An emergence of vancomycin resistant organisms particularly vancomycin-resistant enterococci
(VRE) has become a serious public health concern. To prevent and control the spread of vancomycin resistant
organisms, the prudent use of vancomycin is strongly recommended by the Hospital Infection Control Prac-
tices Advisory Committee (HICPAC).
Materials and Methods : A 6-week prospective observational study of vancomycin use was conducted in hospi-
talized patients at Siriraj Hospital from February to March 2005. Indications of initiating and continuing
vancomycin were categorized according to HICPAC recommendations. Factors related to the appropriate-
ness of vancomycin use were also evaluated.
Results : At initiation, vancomycin was inappropriately and empirically prescribed 19/222 times (8.6%) and
166/222 times (74.8%), respectively. After microbiological results were obtained, the rate of inappropriate
prescription continued 132/222 times (59.5%). Furthermore, inappropriate use was significantly correlated
with the type of department. There was a higher rate in the Department of Pediatrics, Surgery and Ophthalmology
when compared with that of the Department of Medicine (p = 0.001). The inappropriate use also correlated
with topical use (p < 0.001), intravenous administration (p = 0.012) and no consultation with an infectious
disease specialist (p = 0.001). The overuse did not improve the clinical outcome.
Conclusion : A substantial rate of inappropriate use of vancomycin was found in Siriraj Hospital. Intervention
to improve appropriateness of vancomycin use should be urgently implemented to prevent and control the
emergence of vancomycin resistant organisms.
Keywords : Anti-bacterial agents, Therapeutic use, HICPAC recommendation, Prospective observational studies, Vancomycin
