EPIDEMIOLOGY OF VANCOMYCIN USAGE AT A CHILDRENS-HOSPITAL, 1993 THROUGH 1995

Objective. To describe the epidemiology of vancomycin usage at a child ren's hospital. Methods. A cohort study of patients at Egleston Childr en's Hospital who were charged for the receipt of vancomycin from Octo ber, 1992, through October, 1995, was performed. Data were obtained fr om pharmacy charge records in the hospital's medical records informati on system. Results. During the study period there were 3589 patient ho spitalizations in which vancomycin was used. Patients receiving vancom ycin were predominantly male (56.6%) and white (62.4%), ranged in age from 0 to 31 (median, 3.8) years and had an average length of stay of 6.0 days. The total number of vancomycin doses was 105 704; the median number of vancomycin doses during each patient hospitalization was 11 .0 (range, 1 to 1215). The total charge for vancomycin used was $2 009 746; the median charge for vancomycin per patient was $297.50 (range, $11 to 19 864). The majority (75.7%) of vancomycin doses were given o n the hematology (27.6%), neurosurgery (17.9%), cardiothoracic surgery (13.4%), neonatology (9.7%) or general pediatrics (7.1%) services. Ov erall surgery service patients were significantly more likely to recei ve vancomycin than were medicine service patients (1267 doses/6221 adm issions vs. 1954/19 446; relative risk, 2.03; P < 0.001). During the s tudy period the number of vancomycin doses decreased significantly (P < 0.001). Conclusions. This study shows the value of evaluating antimi crobial use through a pharmacy database. Although vancomycin use decre ased during the study period, large amounts of vancomycin are still be ing prescribed primarily on subspecialty service patients. Interventio ns to reduce vancomycin use should focus on these groups.