Curtailing unnecessary vancomycin usage in a hospital with high rates of methicillin resistant Staphylococcus aureus infections

Aims To implement and monitor the effectiveness of a strategy to curb unnec essary use of vancomycin and teicoplanin for inpatients in a teaching hospi tal/tertiary referral centre where 33% of S. aureus isolates (72% from ICU patients) were methicillin resistant. Methods A sample of 182 vancomycin/teicoplanin inpatient prescriptions surv eyed, revealed that only 31 (17%) conformed with Centre for Disease Control (CDC) guidelines. Following education (ward-rounds, bulletins) on appropri ate CDC based guidelines for prescribing glycopeptides directed at relevant clinicians, 'Immediate Concurrent Feedback' (ICF) was gradually deployed t hroughout the hospital. This entailed review of respective inpatient record s on the next working day. If the indication was deemed not to conform with our guidelines, the prescriber was issued a memo (copied to the supervisin g doctor). Each memo detailed the 'errant' incident, listed appropriate ind ications and explicitly advised desisting from such prescribing and suggest ed alternative therapy if necessary. Corresponding glycopeptide usage data for our hospital and others in Hong Kong were retrieved and analysed as wer e samples of records of our inpatients with staphylococcal septicaemia (pre and during ICF). Results Compared with baseline values, during 2 years of ICF, inpatient pre scribing of vancomycin and teicoplanin deemed to conform increased to 71% ( 773/1086); difference 54% (P < 0.0001, 95% Cis 47-62%). Corresponding avera ge monthly usage (DDDs/1000 admissions) decreased from 76 (pre-ICF) to 45; mean difference 31 (P < 0.0001, 95% CIs 24, 38). Mortality from staphylococ cal bacteraemia remained unchanged. No comparable changes in glycopeptide u sage ensued in comparator hospitals. Conclusions ICF can be used safely to curb irrational overuse of vancomycin and teicoplanin in a hospital with high methicillin resistant S. aureus in fection rates.