Appropriateness of intravenous vancomycin prescribing in a Canadian acute care hospital
Bibliographic record
Abstract
Background: There are associated adverse effects with intravenous (IV) vancomycin, yet there is a paucity of published literature surveying the appropriateness of use. The objective of the study was to assess the appropriateness of IV vancomycin prescriptions at a Canadian acute care hospital. Methods: A pilot, pragmatic antimicrobial stewardship initiative using prospective audit and feedback (PAF) was conducted on incident IV vancomycin prescriptions for 4 weeks in 2022. The primary outcome was the percentage of IV vancomycin prescriptions assessed as appropriate against institutional prescribing guidelines. The secondary outcomes were to evaluate factors affecting appropriateness and to determine the number and types of ASP recommendations where IV vancomycin was assessed as suboptimal. Results: Out of 109 prescriptions audited, 43 (39%) were assessed to be suboptimal. Discontinuing or changing the agent was recommended in 39 cases (91%) and regimen optimization (duration or frequency change) was only recommended in only 4 (9%). ASP recommendations were fully or partially accepted in 88%. Infectious disease consultation (IDC) was associated with greater appropriateness (83% versus 53%; p = 0.004), as was Methicillin resistant Staphylococcus aureus (MRSA) colonization (75% versus 55%; p = 0.047), but not acute kidney injury (AKI) (62% versus 60%; p = 0.889). Adjusting for age, AKI and MRSA colonization, IDC remained a significant predictor of vancomycin appropriateness (adjusted odds ratio [aOR] = 4.27, [95% CI 1.44 to 12.70]; p = 0.009). Conclusions: Prospective audit and feedback demonstrated inappropriate IV vancomycin use at our centre and an opportunity for quality improvement.
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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 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".