Vancomycin use in pediatric neurosurgery patients

Objective: The objective of this article is to describe a pediatric neurosu rgery patient population receiving vancomycin and examine the indications f or and appropriateness of vancomycin use. Methods: A cross-sectional study was performed on the pediatric neurosurger y patients at Egleston Children's Hospital who received vancomycin from Jan uary 1 through December 31, 1996. Vancomycin use was compared with the Cent ers for Disease Control and Prevention Hospital Infection Control Practices Advisory Committee recommendations for vancomycin use. Results: Thirty patients received 115 doses of vancomycin. The median patie nt age was 8.0 years, and 17 (56.7%) were male. Vancomycin was used for pro phylaxis in 28 (93.3%) patients and empiric therapy in 3 (10.0%) patients; one patient received vancomycin for surgical prophylaxis followed by empiri c therapy for suspected meningitis. Vancomycin prophylaxis was initiated af ter the incision in 6 (21.4%) patients and was continued as prophylaxis for more than one dose in 26 (92.9%) patients. Conclusions: Vancomycin was used primarily as surgical prophylaxis in pedia tric neurosurgery patients, and use was not consistent with the Hospital In fection Control Practices Advisory Committee recommendations. These data su ggest that for certain subpopulations, such as pediatric neurosurgery patie nts, there is a need for more specialized recommendations. Furthermore, pru dent vancomycin use is warranted to successfully decrease the risk of furth er emergence of vancomycin resistance. Because vancomycin use may be preval ent in this population, assessment of vancomycin use in pediatric neurosurg ery patients followed by establishment of vancomycin clinical guidelines ma y help improve the appropriateness of vancomycin use in this population.