Knowledge of Centers for Disease Control and Prevention guidelines for theuse of vancomycin at a large tertiary care children's hospital

Objective: In 1994, the Centers for Disease Control and Prevention (CDC) pu blished guidelines to encourage prudent use of vancomycin. We sought to det ermine whether physicians could demonstrate knowledge consistent with the g uidelines. Design: Survey consisting of 18 clinical vignettes based on the CDC guideli nes. Participants: hll residents, fellows, and attending physicians involved in pediatric inpatient services. Setting: Tertiary care children's hospital providing service to an inner-ci ty population and community referral base. Main outcome measures: Comparison of sun ey scores and individual responses among respondents. Results: Survey scores did not vary with level of training or whether the r espondent was a pediatrician or non-pediatrician. Average scores of attendi ng physicians, fellows, and residents were 74.1% (SD = 13.1), 77.2% (SD = 1 1.5), and 73.4% (SD = 10.5), respectively, and did not differ significantly . Questions incorrectly answered by more than 30% of respondents concerned the use of vancomycin as: (1) first-line treatment of Clostridium difficile colitis, (2) a topical solution for wound infection, (3) initial, empiric treatment of patients with fel er and neutropenia, (4) peri-operative proph ylaxis, (5) a preferred agent over beta -lactam antimicrobial agents. Conclusion: Deficits in knowledge regarding appropriate vancomycin use can be localized to certain clinical settings. This observation lends optimism to the notion that targeted educational intervention may improve the approp riate use of vancomycin.