Restrict vancomycin use to curtail resistant staph
Efforts to reduce the overuse of antimicrobials will decrease the risk that staphylococci with reduced susceptibility to vancomycin will emerge, the Centers for Disease Control and Prevention advises.1 Antimicrobial use is a major risk factor for the emergence of antimicrobial-resistant pathogens. In that regard, medical and ancillary staff members who are responsible for pharmacy formulary decisions should review and restrict use of vancomycin and ensure that use of other antimicrobials is appropriate.2 Vancomycin use should be discouraged in the following situations:
• routine surgical prophylaxis other than in a patient who has a life-threatening allergy to beta-lactam antibiotics;
• empiric antimicrobial therapy for a febrile neutropenic patient, unless initial evidence indicates that the patient has an infection caused by gram-positive microorganisms (e.g., at an inflamed exit site of Hickman catheter) and the prevalence of infections caused by MRSA in the hospital is substantial;
• treatment in response to a single blood culture positive for coagulase-negative staphylococcus, if other blood cultures taken during the same time frame are negative (i.e., if contamination of the blood culture is likely);
• continued empiric use for presumed infections in patients whose cultures are negative for beta-lactam-resistant gram-positive microorganisms;
• systemic or local (e.g., antibiotic lock) prophylaxis for infection or colonization of indwelling central or peripheral intravascular catheters;
• selective decontamination of the digestive tract;
• eradication of MRSA colonization;
• primary treatment of antibiotic-associated colitis;
• routine prophylaxis for very low birth weight infants;
• routine prophylaxis for patients on continuous ambulatory peritoneal dialysis or hemodialysis;
• treatment (chosen for dosing convenience) of infections caused by beta-lactam-sensitive gram-positive microorganisms in patients who have renal failure;
• use of vancomycin solution for topical application or irrigation.
References
1. Centers for Disease Control and Prevention. Interim guidelines for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin. MMWR 1997; 46:626-628.
2. Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995; 44:(RR-12)1-13.
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