Monitoring antimicrobial use and resistance: Comparison with a national benchmark on reducing vancomycin use and vancomycin-resistant enterococci

• Type of Material: Article
• Authors: Scott K. Fridkin, Emory University; Rachel Lawton, Centers for Disease Control and Prevention; Jonathan R. Edwards, Centers for Disease Control and Prevention; Fred C. Tenover, Emory University; John E McGowan Jr., Emory University; Robert Gaynes, Emory University
• Language: English
• Date: 2002-07-01
• Publisher: Centers for Disease Control and Prevention
• Publication Version: Final Published Version
• Copyright Statement: Articles from Emerging Infectious Diseases are provided here courtesy of Centers for Disease Control and Prevention
• Final Published Version (URL): http://dx.doi.org/10.3201/eid0807.010465
• Title of Journal or Parent Work: Emerging Infectious Disease
• ISSN: 1080-6040
• Volume: 8
• Issue: 7
• Start Page: 702
• End Page: 707
• Grant/Funding Information: This work was supported in part by grants to the Rollins School of Public Health of Emory University for Phase 2 and 3 of Project ICARE by AstraZeneca International, Pfizer Inc., and Hoffmann-La Roche Inc. as full sponsors, and Aventis Pharma (formerly Rhone-Poulenc Rorer), the National Foundation for Infectious Diseases, The American Society for Health Systems Pharmacists Research and Education Foundation, Kimberly-Clark Corporation, and Bayer Corporation, Pharmaceuticals Division as partial sponsors.
• Keywords: Infectious Diseases; MICROORGANISMS; QUALITY IMPROVEMENT; Nosocomial infections; SURGERY; Benchmarking; EMERGENCE; GUIDELINES; NOSOCOMIAL INFECTIONS; LEADERS; Surveillance; Quality; Immunology; Life Sciences & Biomedicine; Science & Technology; Antibiotic resistance; UNITED-STATES HOSPITALS; SURVEILLANCE
• Research Categories: Health Sciences, Epidemiology; Biology, Microbiology; Health Sciences, Public Health

Abstract

To determine if local monitoring data on vancomycin use directed quality improvement and decreased vancomycin use or vancomycin-resistant enterococci (VRE), we analyzed data from 50 intensive-care units (ICUs) at 20 U.S. hospitals reporting data on antimicrobial-resistant organisms and antimicrobial agent use. We compared local data with national benchmark data (aggregated from all study hospitals). After data were adjusted for changes in prevalence of methicillin-resistant Staphylococcus aureus, changes in specific prescriber practice at ICUs were associated with significant decreases in vancomycin use (mean decrease -48 defined daily doses per 1,000 patient days, p < 0.001). These ICUs also reported significant decreases in VRE prevalence compared with those not using unit-specific changes in practice (mean decrease of 7.5% compared with mean increase of 5.7%, p < 0.001). In this study, practice changes focused towards specific ICUs were associated with decreases in ICU vancomycin use and VRE prevalence.