Evaluation of vancomycin use in university-affiliated hospitals in Southern Khorasan Province (East Iran) based on HICPAC guidelines

Figures & data

Figure 1 Appropriateness of vancomycin utilization by hospitals (based on Healthcare Infection Control Practices Advisory Committee criteria).

Table 1 Variables and values of the study

Variable	Value
Number of patients
Valiasr Hospital, n (%)	201 (67.4%)
Imam Reza Hospital, n (%)	97 (32.6%)
Total	298
Age, years, mean ± SD	55.96±12.6 years
Length of vancomycin treatment, mean ± SD	10.54±7.88 days
Distribution of vancomycin use by service, n (%)
Infection	82 (27.4%)
Surgery	29 (9.7%)
Internal medicine	46 (15.4%)
ICU	54 (18.1%)
Orthopedic	39 (13%)
Pediatric	32 (10.7%)
PICU	9 (3%)
NICU	7 (2.7%)
Comorbid patients, n (%)
Surgery	76 (41%)
Malignancy	29 (15.5%)
Diabetes	32 (17%)
Immunosuppression	47 (25.5%)
Transplantation	2 (1%)
Injection method, n (%)
Fast infusion	3 (1.01%)
0.5-hour infusion	3 (1.01%)
1-hour infusion	32 (10.74%)
2-hour infusion	6 (2.01%)
Unknown	254 (85.23%)
Treatment outcome, n (%)
Fully recovered	59 (21%)
Partially recovered	174 (62%)
Death	32 (12%)
Reference	14 (5%)
Side effect during injection, n (%)
Asthma	1 (0.3%)
Rash	1 (0.3%)
Erythema and itching	1 (0.3%)
Culture, n (%)
Sputum	11 (7.5%)
Blood	108 (73.9%)
Urine	80 (47%)
Wound	3 (2%)
Angiocath	0 (0.0 %)
CV line	5 (3.5%)
Tumor discharge	1 (0.7%)
Bronchoalveolar secretion	1 (0.7%)
Synovial fluid	1 (0.7%)
Body fluid	3 (2%)
Time of culture, n (%)
Simultaneous with vancomycin use	88 (60.3%)
24 hours after vancomycin use	13 (8.9%)
72 hours after vancomycin use	15 (10.3%)
After 72 hours	22 (15.1%)
Other time	8 (5.4%)
Reason for use, n (%)	2 (0.7%)
Pneumonia	110 (36.7%)
Catheter-related infections	29 (9.6%)
Meningitis	93 (31.1%)
Skin infection	7 (2.3%)
Urinary tract infection	3 (1%)
Peritonitis	3 (1%)
Endocarditis	47 (15.7%)
Septicemia, other	50 (16.7%)

Abbreviations: CV, cardiovascular; ICU, intensive care unit; NICU, neonatal intensive care unit; PICU, pediatric intensive care unit.

Table 2 Concomitant use of other antibiotics and drugs with vancomycin

Antibiotic	Value, n (%)
Aminoglycosides	3 (5.7%)
Nonsteroidal anti-inflammatory drugs	11 (20.8%)
Cephalosporin	12 (22.6%)
Calcium channel blockers	15 (28.2%)
Cyclosporine	1 (1.9%)
Aminoglycosides and nonsteroidal anti-inflammatory drugs	1 (1.9%)
Aminoglycosides and cephalosporin	2 (3.8%)
Nonsteroidal anti-inflammatory drugs and cephalosporin	4 (7.5%)
Nonsteroidal anti-inflammatory drugs and calcium channel blockers	2 (3.8%)
Cephalosporin and calcium channel blockers	1 (1.9%)
Nonsteroidal anti-inflammatory drugs and calcium channel blockers and cephalosporin	1 (1.9%)

Table 3 Appropriateness of vancomycin utilization by different wards (based on HICPAC criteria)

Ward	Accordance, n (%)	Nonaccordance, n (%)
Infection	73 (90%)	9 (10%)
Surgery	20 (83.3%)	4 (16.7%)
Internal medicine	38 (86.4%)	6 (13.6%)
ICU	45 (86.5%)	7 (13.5%)
Orthopedic	17 (94.4%)	1 (5.6%)
Pediatric	29 (96.7%)	1 (3.3%)
PICU	7 (87.5%)	1 (12.5%)
NICU	1 (100%)	0 (0.0%)

Abbreviations: HIPAC, Healthcare Infection Control Practices Advisory Committee; ICU, intensive care unit; NICU, neonatal intensive care unit; PICU, pediatric intensive care unit.

Table 4 Drug–drug interaction with vancomycin that may lead to increased nephrotoxicity in the study population (n=298)

Drug–drug interaction	Percentage of total cases
Vancomycin + gentamicin	6.5%
Vancomycin + amikacin	12.5%