Determinants of vancomycin use in adult intensive care units in 41 United States hospitals

We analyzed data from a prospective observational cohort study that include d 108 adult intensive care units (ICUs) in 41 United States hospitals. Use of vancomycin (defined daily doses per 1,000 patient-days), nosocomial infe ction rates, and proportion of all Staphylococcus aureus isolates resistant to methicillin (MRSA rate) were recorded from January 1996 through Novembe r 1997, The median rate of vancomycin use was lowest in coronary care ICUs and highest in general surgical ICUs, Prior approval before use of vancomyc in was required in only 26 (24%) of the 108 ICUs. In a multivariate linear regression model, rates of MRSA, central line-associated bloodstream infect ion, and the type of ICU were independent predictors of vancomycin use. Non e of the vancomycin control practices was associated with lower rates of va ncomycin use; however, it is important to recognize that this database was not designed to measure rates of inappropriate use. Vancomycin use is heavi ly determined by rates of endemic MRSA and central line-associated bloodstr eam infection. Efforts to reduce these rates through infection control acti vities should be included in hospitals' efforts to reduce vancomycin use.