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

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.

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.

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.