Evaluation of vancomycin use in university-affiliated hospitals in Southern Khorasan Province (East Iran) based on HICPAC guidelines

Motahare Mahi-Birjand,1 Masood Ziaee,1 Bita Bijari,1 Reza Khalvati,2 Mohammad Reza Abedini,3 Hasan Golboei Mousavi,4 Arash Ziaee5 1Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran; 2Food and Drug Administration, Mazandaran University of Medical Sciences, Mazandaran, Iran; 3Department of Pharmacology, Cellular and Molecular Research Center, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran; 4Department of Otolaryngology, Birjand University of Medical Sciences, Birjand, Iran; 5Mashhad University of Medical Sciences, Mashhad, Iran Background: Vancomycin resistance has raised concerns about its effectiveness prospect in the treatment of patients with Gram-positive infections. The Healthcare Infection Control Practices Advisory Committee (HICPAC) has recently established guidelines to delineate improper use of vancomycin. In this light, we sought out to determine the appropriateness of vancomycin prescription using the HICPAC guidelines.Setting: The study was carried out in two university-affiliated hospitals, Valiasr and Imam Reza, with 297 and 234 beds, respectively, from May 2012 to May 2013. Methods: This retrospective study evaluated the vancomycin prescription and usage in the hospitals. Total vancomycin use was determined and expressed as vancomycin courses per 298 admitted patients. The patient information was collected on a data collection sheet as follows: demographic variables, etiology and localization of infection, microbiological data, duration of vancomycin treatment, reasons for vancomycin prescription, prescribed antibiotic dosing, and patient regimen. Results: The average age of the patients and vancomycin treatment duration were 55.965 years and 10.5 days, respectively. Septicemia (15.7%) was the most common cause of vancomycin administration. Vancomycin use was documented to be appropriate and inappropriate in 236 (89.4%) and 28 (10.6%) patients, respectively. No statistically significant differences were found among the wards and hospitals (P values =0.66 and 0.54, respectively) in terms of appropriateness of vancomycin use based on the HICPAC criteria. In addition, 29.21% and 62% of all patients exhibited complete and partial recovery, respectively. We found that 90% of the cases showed compliance with the HICPAC recommendations. Conclusion: Comprehensive programs are required to improve the vancomycin use in the hospitals. Vancomycin use should be monitored due to its large-scale empiric use. The rate of improper use of vancomycin in the infection and intensive care unit services may be high, and pharmacists must take appropriate action to optimize the use of the drug. Keywords: vancomycin, drug utilization, anti-bacterial agents, university hospital