Physicians circumvent vancomycin controls
Physicians circumvent vancomycin controls
Just as the Centers for Disease Control and Prevention responded to last year’s cases of vancomycin resistance with general use guidelines, the agency was wrapping up a 12-month study of the drug’s use at 38 hospitals.
"Restrictions on antibiotics are not as common as you’d think. Most doctors can do whatever they want with antibiotics," says Robert Gaynes, MD, chief of surveillance activity in the Hospital Infections Program of the CDC’s Center for Infectious Diseases. "Penicillin allergies are vastly overdiagnosed," he adds, which in turn leads to more unneeded vancomycin use.
The surveillance survey found that of the 38 hospitals visited, 18% had an antibiotic order form system, 13% had an approval protocol for vancomycin use, 53% had automatic stop orders for all antibiotics, and 8% had stop orders for specific antibiotics. Oddly, Gaynes found that in the hospitals requiring approval for vancomycin use, actual use of the drug was higher than in hospitals with no approval policy, reflecting a possible false sense of security. Equally unexpected, the study found that hospitals with stop orders used more vancomycin than did hospitals without them.
He also notes that 18% to 26% of hospitals, depending on the settings and structures, include pharmacists on rounds, but that’s no guarantee the abuse will be curbed. "The mere presence of a pharmacist in the ICU does not affect prescribing patterns. A multidisciplinary approach is the only hope."
Overall, the study found that vancomycin’s use was higher in hospitals with 500 or more beds or in surgical ICUs than in teaching hospitals. The drug’s use was higher for bloodstream and infection control procedures but lower for pneumonia and urinary tract treatments. Other possible use factors like length of stay, the number of ICU beds, or the number of patient days per month did not notably affect the use of vancomycin. What did work, he says, were established clinical practice guidelines. Where they were in place, they did lower the drug’s use.
The bottom line? "Not until hospital administrations realize we’re on the verge of a post-antibiotics era will the policies really begin to change."
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