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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

Difference (postintervention period minus pre-intervention) in rate of vancomycin use and prevalence of vancomycin-resistant enterococci (VRE) (%) in 35 intensive-care units (ICUs) testing >10 clinical isolates of Enterococci spp., Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE), January 1996–July 1999. Squares represent ICUs reporting a prescriber practice change targeted in the specific ICUs (i.e., ICU-specific practice change). DDD, defined daily doses.
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Figure 2: Difference (postintervention period minus pre-intervention) in rate of vancomycin use and prevalence of vancomycin-resistant enterococci (VRE) (%) in 35 intensive-care units (ICUs) testing >10 clinical isolates of Enterococci spp., Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE), January 1996–July 1999. Squares represent ICUs reporting a prescriber practice change targeted in the specific ICUs (i.e., ICU-specific practice change). DDD, defined daily doses.

Mentions: Thirty-five (70%) of the 50 study ICUs tested at least 10 isolates of enterococci for vancomycin susceptibility and were included in the calculations of VRE prevalence during both pre- and postintervention periods. During the pre-intervention period, these ICUs reported a median VRE prevalence of 11.7%. Overall, VRE prevalence increased during the postintervention period compared with the pre-intervention period among all study ICUs (median difference +2.3%; range –41% to +32%), although this difference was not statistically significant. However, when compared by type of practice change, the difference in VRE prevalence was significantly lower in ICUs in which unit-specific practice changes occurred, compared with other ICUs (mean difference -7.5% vs. +5.7%, p<0.001). Although many of the ICUs with decreases in vancomycin use reported increases in percent VRE, all the ICUs noting a unit-specific practice change reported decreases in both percent VRE and vancomycin use (Figure 2). Analysis of these data by using either the relative change in percent VRE or vancomycin use obtained results of similar statistical significance. However, since the relative changes were commonly of extreme values (range 0–400%), these are not reported here.


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)

Difference (postintervention period minus pre-intervention) in rate of vancomycin use and prevalence of vancomycin-resistant enterococci (VRE) (%) in 35 intensive-care units (ICUs) testing >10 clinical isolates of Enterococci spp., Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE), January 1996–July 1999. Squares represent ICUs reporting a prescriber practice change targeted in the specific ICUs (i.e., ICU-specific practice change). DDD, defined daily doses.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Difference (postintervention period minus pre-intervention) in rate of vancomycin use and prevalence of vancomycin-resistant enterococci (VRE) (%) in 35 intensive-care units (ICUs) testing >10 clinical isolates of Enterococci spp., Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE), January 1996–July 1999. Squares represent ICUs reporting a prescriber practice change targeted in the specific ICUs (i.e., ICU-specific practice change). DDD, defined daily doses.
Mentions: Thirty-five (70%) of the 50 study ICUs tested at least 10 isolates of enterococci for vancomycin susceptibility and were included in the calculations of VRE prevalence during both pre- and postintervention periods. During the pre-intervention period, these ICUs reported a median VRE prevalence of 11.7%. Overall, VRE prevalence increased during the postintervention period compared with the pre-intervention period among all study ICUs (median difference +2.3%; range –41% to +32%), although this difference was not statistically significant. However, when compared by type of practice change, the difference in VRE prevalence was significantly lower in ICUs in which unit-specific practice changes occurred, compared with other ICUs (mean difference -7.5% vs. +5.7%, p<0.001). Although many of the ICUs with decreases in vancomycin use reported increases in percent VRE, all the ICUs noting a unit-specific practice change reported decreases in both percent VRE and vancomycin use (Figure 2). Analysis of these data by using either the relative change in percent VRE or vancomycin use obtained results of similar statistical significance. However, since the relative changes were commonly of extreme values (range 0–400%), these are not reported here.

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