Vancomycin is an antibiotic that is used to treat antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA). But vancomycin can also cause kidney injury when it’s used for more than 48 hours, so it’s important to only use it when necessary, because better and safer alternative antibiotics are available for most situations.
As director of the antimicrobial stewardship program at Children’s National, Rana Hamdy, M.D., MSCE, M.P.H., tracks antibiotic use at the hospital. When Dr. Hamdy looked at how much vancomycin was being used in the neonatal intensive care unit (NICU), she discovered that the department was prescribing the antibiotic almost three times as much as other hospitals, even though the rates of MRSA infections were very low.
Prompted by this finding, Dr. Hamdy assembled a multidisciplinary team consisting of neonatologists, NICU nurses and nurse practitioners, infectious disease experts and pharmacists. Their goal was to reduce vancomycin use in the NICU by 50% in one year and to sustain that level for at least another year. The team developed and implemented several interventions, including standardizing the hospital’s approach to treating several types of infections, integrating pharmacists into the antibiotic review process, and educating clinicians on antibiotic use.
Within one year, vancomycin use in the NICU was down by 60%. Before the project, one infant per week was developing vancomycin-associated kidney injury, but in the six months after the last phase of the project, there were no episodes of vancomycin-associated kidney injury in the NICU. As an added benefit, the use of other antibiotics in the NICU also declined by about 20%.