Original Research
Saturday, October 12, 2024
11:30 AM–01:00 PM
Abstract
Introduction: Overuse of vancomycin can lead to the development of resistant organisms. Studies have demonstrated that guideline implementation reduces the use of vancomycin without increasing morbidity and mortality. The purpose of this study is to evaluate the difference in judicious vancomycin courses and outcomes before and after guideline implementation with the goal of further reducing non-judicious use in the neonatal intensive care unit (NICU).
Research Question or Hypothesis: Adherence to the guideline will increase the percentage of judicious vancomycin courses compared to pre-guideline use without adversely impacting clinical outcomes.
Study Design: This was a retrospective chart review of infants in the NICU at University of Illinois Hospital & Health Sciences System between 2020 and 2023.
Methods: The study evaluated infants who received empiric antibiotics for late onset sepsis or necrotizing enterocolitis in the NICU during that timeperiod. The primary outcome was the difference in judicious vancomycin courses before and after guideline implementation. Secondary outcomes included the difference in survival at discharge and vancomycin levels drawn along with an evaluation of risk factors that could predict the likelihood of vancomycin necessity.
Results: Before guideline implementation, 134 of 263 (51%) empiric vancomycin courses were defined as judicious compared to 79 of 110 (71.8%) courses following guideline implementation (p=0.001). In courses where patients grew coagulase negative Staphylococcus or methicillin-resistant Staphylococcus aureus requiring vancomycin therapy, there was a statistically significant difference in the percentage of those receiving TPN (78.6% vs 57.3%, p=0.0446) and requiring vasopressors (28.6% vs 7.3%, p=0.0036) compared to the courses that did not require vancomycin therapy. All-cause mortality (6.2% vs 7.1%, p=0.7917) and infection-related mortality (3.7% vs 5.7%, p=0.4951) were not different before and after guideline implementation.
Conclusion: Implementation of an empiric antibiotic guideline in the NICU can significantly decrease non-judicious use of vancomycin without negatively impacting clinical outcomes. Continued education remains imperative in decreasing non-judicious use of antibiotics.
Presenting Author
Kirsten Ohler Pharm.D.University of Illinois at Chicago
Authors
Avery Claire Jones PharmD
The University of Illinois Chicago College of Pharmacy
Jennifer Pham PharmD, BCPS, BCPPS
University of Illinois Chicago