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

Fridkin SK, Lawton R, Edwards JR, Tenover FC, McGowan JE, Gaynes RP, Intensive Care Antimicrobial Resistance Epidemiology ProjectNational Nosocomial Infections Surveillance Systems Hospita - Emerging Infect. Dis. (2002)

Bottom Line: We compared local data with national benchmark data (aggregated from all study hospitals).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.

View Article: PubMed Central - PubMed

Affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. skf0@cdc.gov

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.

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Related in: MedlinePlus

Boxplot of benchmark data of vancomycin use at all Phase 2 Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals (n=113 intensive-care units [ICUs]) in October 1997, by type of ICU (18). ICU types include pediatric (P), coronary (C), combined medical-surgical (MS), neurosurgical (NS), surgical (S), and cardiothoracic (CT). For each type of ICU, boxes represent rates of vancomycin use at the 25th–75th percentiles (interquartile range), and ends of vertical lines represent values at the 10th–90th percentiles. Horizontal lines represent median values in each ICU type. Additionally, plotted circles represent the rate of vancomycin use in the pre-intervention period (1996–1997) in the 50 ICUs participating in the intervention study, and open circles represent the 10 ICUs reporting a prescriber practice change identified in the specific unit (i.e., ICU-specific practice change) (1 burn ICU not shown). DDD, defined daily doses.
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Figure 1: Boxplot of benchmark data of vancomycin use at all Phase 2 Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals (n=113 intensive-care units [ICUs]) in October 1997, by type of ICU (18). ICU types include pediatric (P), coronary (C), combined medical-surgical (MS), neurosurgical (NS), surgical (S), and cardiothoracic (CT). For each type of ICU, boxes represent rates of vancomycin use at the 25th–75th percentiles (interquartile range), and ends of vertical lines represent values at the 10th–90th percentiles. Horizontal lines represent median values in each ICU type. Additionally, plotted circles represent the rate of vancomycin use in the pre-intervention period (1996–1997) in the 50 ICUs participating in the intervention study, and open circles represent the 10 ICUs reporting a prescriber practice change identified in the specific unit (i.e., ICU-specific practice change) (1 burn ICU not shown). DDD, defined daily doses.

Mentions: In the 50 study ICUs, the rates of vancomycin use during the pre-intervention period (Figure 1, plotted circles) were similar in range to the 113 ICARE Phase 2 ICUs contributing data to the national aggregate benchmark report (Figure 1, box plots). The overall (pooled mean) ICU-specific use of vancomycin in the 50 ICUs at the 20 study hospitals after the intervention was 89.1 defined daily doses per 1,000 patient-days, a 2.8% increase over the pre-intervention rate of use (86.6 defined daily doses per 1,000 patient-days). Despite this increase in aggregate usage among all ICUs, most ICUs reported lower rates of vancomycin use after the intervention compared with the pre-intervention rates. The median difference was -3 defined daily doses per 1,000 patient days (range -138 to +196), but this difference was not statistically significant.


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

Fridkin SK, Lawton R, Edwards JR, Tenover FC, McGowan JE, Gaynes RP, Intensive Care Antimicrobial Resistance Epidemiology ProjectNational Nosocomial Infections Surveillance Systems Hospita - Emerging Infect. Dis. (2002)

Boxplot of benchmark data of vancomycin use at all Phase 2 Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals (n=113 intensive-care units [ICUs]) in October 1997, by type of ICU (18). ICU types include pediatric (P), coronary (C), combined medical-surgical (MS), neurosurgical (NS), surgical (S), and cardiothoracic (CT). For each type of ICU, boxes represent rates of vancomycin use at the 25th–75th percentiles (interquartile range), and ends of vertical lines represent values at the 10th–90th percentiles. Horizontal lines represent median values in each ICU type. Additionally, plotted circles represent the rate of vancomycin use in the pre-intervention period (1996–1997) in the 50 ICUs participating in the intervention study, and open circles represent the 10 ICUs reporting a prescriber practice change identified in the specific unit (i.e., ICU-specific practice change) (1 burn ICU not shown). DDD, defined daily doses.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369588&req=5

Figure 1: Boxplot of benchmark data of vancomycin use at all Phase 2 Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals (n=113 intensive-care units [ICUs]) in October 1997, by type of ICU (18). ICU types include pediatric (P), coronary (C), combined medical-surgical (MS), neurosurgical (NS), surgical (S), and cardiothoracic (CT). For each type of ICU, boxes represent rates of vancomycin use at the 25th–75th percentiles (interquartile range), and ends of vertical lines represent values at the 10th–90th percentiles. Horizontal lines represent median values in each ICU type. Additionally, plotted circles represent the rate of vancomycin use in the pre-intervention period (1996–1997) in the 50 ICUs participating in the intervention study, and open circles represent the 10 ICUs reporting a prescriber practice change identified in the specific unit (i.e., ICU-specific practice change) (1 burn ICU not shown). DDD, defined daily doses.
Mentions: In the 50 study ICUs, the rates of vancomycin use during the pre-intervention period (Figure 1, plotted circles) were similar in range to the 113 ICARE Phase 2 ICUs contributing data to the national aggregate benchmark report (Figure 1, box plots). The overall (pooled mean) ICU-specific use of vancomycin in the 50 ICUs at the 20 study hospitals after the intervention was 89.1 defined daily doses per 1,000 patient-days, a 2.8% increase over the pre-intervention rate of use (86.6 defined daily doses per 1,000 patient-days). Despite this increase in aggregate usage among all ICUs, most ICUs reported lower rates of vancomycin use after the intervention compared with the pre-intervention rates. The median difference was -3 defined daily doses per 1,000 patient days (range -138 to +196), but this difference was not statistically significant.

Bottom Line: We compared local data with national benchmark data (aggregated from all study hospitals).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.

View Article: PubMed Central - PubMed

Affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. skf0@cdc.gov

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.

Show MeSH
Related in: MedlinePlus