An Assessment of Vancomycin Use in 2 Tertiary Care Hospitals
Bibliographic record
Abstract
ABSTRACT Background and Objective: The emergence of vancomycin resistance among gram-positive organisms over the past 10 years has raised serious health concerns worldwide. In response, several government organizations have developed recommendations for the appropriate use of vancomycin. The goal of this study was to assess the appropriateness of vancomycin use at 2 tertiary care teaching hospitals in relation to a set of modified guidelines. Methods: All adult patients receiving vancomycin at the Health Sciences Centre and St Boniface General Hospital in Winnipeg, Manitoba, between October 1 and November 30, 1999, were eligible for prospective or retrospective chart review. Patients were identified during order entry and by means of the pharmacy information system. Each patient’s vancomycin therapy was assessed according to modified Centers for Disease Control and Prevention and Laboratory Centre for Disease Control guidelines. Results: A total of 199 courses of vancomycin therapy were assessed. Vancomycin was started for prophylaxis in 54 (27%) cases, empiric use in 116 (58%) cases, and documented infections in 28 (14%) cases (indication was unknown in one case). Vancomycin use was inappropriate in 89 (45%) of 199 courses of therapy. Inappropriate empiric use (52 courses) and prophylatic use (27 courses) accounted for the majority of these inappropriate cases (58% and 30%, respectively). Conclusions: Vancomycin was prescribed inappropriately in almost half of all cases in these 2 institutions. These results are comparable to previously reported assessments of vancomycin use. Despite availability of guidelines on vancomycin use, it appears that clinician education, improved s-lactam allergy workup, and vigilance are warranted, even in the absence of vancomycin resistance. RESUME Historique et objectif : L’emergence de bacteries Gram-positives resistant a la vancomycine au cours des dix dernieres annees a souleve de serieuses preoccupations pour la sante partout dans le monde. Nombre d’organisations gouvernementales ont reagi en mettant de l’avant des recommandations sur l’utilisation appropriee de la vancomycine. L’objectif de cette etude etait d’evaluer, a partir de lignes directrices modifiees, la pertinence de l’utilisation de la vancomycine dans deux hopitaux universitaires de soins tertiaires. Methodes : Tous les patients adultes du Health Sciences Centre et de l’Hopital general St-Boniface de Winnipeg, au Manitoba, qui ont recu de la vancomycine entre le 1er octobre et le 30 novembre 1999, etaient admissibles a l’etude prospective et retrospective de leurs dossiers medicaux. Les patients ont ete identifies lors de la saisie des ordonnances et a l’aide du systeme d’information de la pharmacie. Pour chacun des patients, le traitement a la vancomycine a ete evalue en fonction des lignes directrices modifiees des Centers for Disease Control and Prevention et du Laboratoire de lutte contre la maladie. Resultats : Au total, 199 traitements a la vancomycine ont ete evalues. La vancomycine a ete prescrite comme traitement prophylactique dans 54 (27 %) cas, comme traitement empirique dans 116 (58 %) cas et dans 28 (14 %) cas documentes d’infections (aucune indication n’etait specifiee dans un des cas). L’utilisation de la vancomycine etait inappropriee dans 89 (45 %) des 199 traitements. Cinquante-deux traitements empiriques et 27 traitements prophylactiques representaient la plupart de ces cas inappropries (respectivement 58 % et 30 %). Conclusions : La vancomycine a ete prescrite de facon inappropriee dans pres de la moitie des cas dans ces deux etablissements. Ces resultats sont comparables a ceux d’etudes anterieures sur l’utilisation de la vancomycine. Malgre la disponibilite de lignes directrices sur l’utilisation de la vancomycine, il semble que l’education des cliniciens, de meilleurs tests d’allergie aux s-lactamines et la vigilance s’imposent, meme en l’absence de resistance a la vancomycine.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".