Knowledge of Vancomycin Use Guidelines among Residents, Fellows, and Attending Physicians in a Pediatric Tertiary Care Center

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Abstract 974 Poster Session IV, Tuesday, 5/4 (poster 139)

Background: The advent of vancomycin-resistant pathogens and the inappropriate use of vancomycin in the hospital setting is a growing concern. Frequent use of vancomycin may increase the potential for the emergence of vancomycin-resistant pathogens. In 1994, to encourage prudent use of vancomycin, the CDC published guidelines describing appropriate and inappropriate uses of vancomycin. We sought to determine whether pediatric residents, fellows, and attending physicians could demonstrate knowledge consistent with these guidelines. Methods: We designed a survey consisting of 18 clinical scenarios based on the CDC guidelines. Each scenario was formatted as a true/false question. Thus, the expected score by chance alone was 50%. The survey was deployed to residents, fellows, and attending physicians of the pediatric general and subspecialty in-patient services at the University of Chicago Children's Hospital. Results: The overall survey response rate was 73% (103/142), consisting of 86% (53/62), 63% (12/19), and 62% (38/61) from residents, fellows, and attending physicians, respectively. There was no evidence that knowledge varied with level of training. Residents, fellows, and attending physicians scored 73%, 77%, and 73% respectively. More than 30% of respondents did not know the correct use of vancomycin in the following clinical situations: 1) treatment of uncomplicated C. difficile colitis without an initial trial of metronidazole, 2) initial empiric regimen in immunosuppressed patients with fever and neutropenia without clinical evidence of gram positive infection, 3) surgical prophylaxis involving prosthetic device implantation in an institution with a high rate of infection with methicillin-resistant Staphylococcus spp., 4) wound irrigation with vancomycin solutions, 5) infection caused by beta-lactam-susceptible gram positive pathogens. Additionally, most respondents were unable to indicate that vancomycin has a lesser bactericidal effect than beta-lactam antimicrobials in the treatment of beta-lactam-susceptible infections. Conclusions: Regardless of training level, most physicians demonstrated some knowledge consistent with the CDC guidelines. However, 5 specific scenarios were missed by the majority of physicians at all levels of training. Four of the 5 frequently missed scenarios would result in overuse of vancomycin. These data suggest that targeted education of residents, fellows, and attending physicians on these specific guidelines may assist in preventing the inappropriate use of vancomycin and therefore slow the spread of vancomycin-resistance determinants among gram positive species.

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