医学
万古霉素
菌血症
重症监护医学
指南
抗菌管理
经验性治疗
心理干预
内科学
抗生素
急诊医学
儿科
金黄色葡萄球菌
抗生素耐药性
微生物学
替代医学
病理
精神科
生物
细菌
遗传学
作者
Kathleen Chiotos,Julie C Fitzgerald,Molly Hayes,Hannah Dashefsky,Talene A. Metjian,Charlotte Woods-Hill,Lauren Biedron,Hannah Stinson,Bon Ku,Sheila Robbins Tighe,Scott L. Weiss,Fran Balamuth,Emily Schriver,Jeffrey S. Gerber
出处
期刊:Pediatrics
[American Academy of Pediatrics]
日期:2022-03-15
卷期号:149 (4)
被引量:2
标识
DOI:10.1542/peds.2021-052165
摘要
Inappropriate vancomycin use is common in children's hospitals. We report a quality improvement (QI) intervention to reduce vancomycin use in our tertiary care PICU.We retrospectively quantified the prevalence of infections caused by organisms requiring vancomycin therapy, including methicillin-resistant Staphylococcus aureus (MRSA), among patients with suspected bacterial infections. Guided by these data, we performed 3 QI interventions over a 3-year period, including (1) stakeholder education, (2) generation of a consensus-based guideline for empiric vancomycin use, and (3) implementation of this guideline through clinical decision support. Vancomycin use in days of therapy (DOT) per 1000 patient days was measured by using statistical process control charts. Balancing measures included frequency of bacteremia due to an organism requiring vancomycin not covered with empiric therapy, 30-day mortality, and cardiovascular, respiratory, and renal organ dysfunction.Among 1276 episodes of suspected bacterial infection, a total of 19 cases of bacteremia (1.5%) due to organisms requiring vancomycin therapy were identified, including 6 MRSA bacteremias (0.5%). During the 3-year QI project, overall vancomycin DOT per 1000 patient days in the PICU decreased from a baseline mean of 182 DOT per 1000 patient days to 109 DOT per 1000 patient days (a 40% reduction). All balancing measures were unchanged, and all cases of MRSA bacteremia were treated empirically with vancomycin.Our interventions reduced overall vancomycin use in the PICU without evidence of harm. Provider education and consensus building surrounding indications for empiric vancomycin use were key strategies.
科研通智能强力驱动
Strongly Powered by AbleSci AI