[Prescriptions of glycopeptides in 10 university hospitals in Paris area: a 1-day survey]

Abstract

Purpose: The prescription of glycopeptides (GP) was evaluated in hospitalized patients.

Methods: A 1-day survey was performed in 10 hospitals of the Île-de-France region regarding the prescription of GP. Characteristics of the included patients, indications of prescription and modalities of GP administration were studied independently of the prescribers.

Results: Overall, 90 patients (median age of 49 years [10 days-89 years]) were treated with a GP (vancomycin: 76; teicoplanin: 14). Indications of therapy included a microbiologically documented infection in 40 cases (44%), an empiric therapy in 44 cases (49%) and a prophylaxis in six cases (7%). In documented infections, main isolated pathogens were: coagulase-negative staphylococci (49%) and Staphylococcus aureus (32%) that were susceptible to methicilline in 27 and 26%, respectively. Vancomycin was administered intravenously (IV) in 71 cases (intermittent dosing in 41 patients (58%) and continuous infusion in 30 patients (42%), as central venous catheter lock in four patients and per os in one patient. In continuously infusion regimens, a loading dose at the initiation of treatment had been administered in 19 cases (63%). The median dosage the first day of curative treatment was <20mg/kg in 10 patients (20% of patients had normal renal function). Teicoplanin (median dosage: 8mg/kg, [3-13]) was IV infused in 86% of cases. Monitoring of serum GP concentrations was performed in only 58% of the cases (vancomycin: 47; teicoplanin: five). A low trough serum concentration was observed in 54% of the 52 monitored patients. The dosage of GP was readapted in only 55% of such cases.

Conclusion: In this 1-day survey, we observed that GP administration was not optimal. Indeed, prolonged prescription of GP as empiric therapy was frequent, monitoring was not systematic, and prescribed dosages were often inadequate.