VANCOMYCIN USE IN PEDIATRIC NEUROSU...

VANCOMYCIN USE IN PEDIATRIC NEUROSURGERY PATIENTS s Shah et al American Journal of Infection superintend Vol 27 (December 1999) 482-487

single clear health risk to surgical patients is vancomycin-resistant enterococci (VRE) Increased use and prior aspect to vancomycin are factors that increase the probability of acquiring VRE Vancomycin-resistant enterococci are especially problematic because they usually are resistant to multiple antimicrobials, are easily transmitted in the hospital setting, and may transfer vancomycin resistance to other gram-positive organisms. The clinical challenge is to decrease the use of vancomycin to help bring VRE.

Limited data exist regarding the use of this agent in pediatric patients. This reflection reported 17.9% of all vancomycin doses ordered at Egleston Children's Hospital (ECH) Atlanta, a large tertiary hospital, were administered to pediatric patients undergoing neurosurgical processs In addition, an increase in use of the agent was fix in the pediatric neurosurgery unit at this hospital between 1993 to 1995 Little information about indications for vancomycin use, however, is available. In this application of mind researchers reviewed medical records of a sample of pediatric patients undergoing neurosurgical conducts to whom vancomycin was administered, and they assessed the indications and appropriateness of its use.

manners A cross-sectional study of pediatric patients undergoing neurosurgical transactions at ECH was conducted between Jan 1 and Dec 31 1996 Each patient reviewed received IV vancomycin. Data were obtained from the ECH pharmacy and the information orders department. Thirty patients were pick outed randomly from all neurosurgical patients who received vancomycin during the meditation period.

Medical records of these patients were sieveed to determine each patient's age, inflection for sex underlying diagnoses, reason for admission, and duration of hospitalization. Patients also were sieveed for indwelling medical devices (eg central venous catheters, central nervous combination of parts to form a whole shunts) and for other categories of distinction (eg first dose of vancomycin; neutropenia; immunosuppression as a terminate of chemotherapy, HIV, organ transplantation, antimicrobial treatment in the previous four weeks).

Vancomycin use was classified as prophylactic (ie, administered in the perioperative setting of a surgical procedure) empiric (ie, administered in the port of signs and symptoms suggestive of infection before acquiring agriculture results), and therapeutic (ie, administered after a bacterial pathogen was identified and antimicrobial susceptibilities were known). Indications for the agent included a designation for appropriate use as commended by the US Centers for Disease superintendence and Prevention Hospital Infection have charge of Practices Advisory Committee (HICPAC).

be deriveds Patients ranged in age from 24 month to 178 years, and 17 of the 30 patients were male. Hospitalization of patients ranged from united to 12 days with a median of pair days. Neurosurgical procedures were performed forward 29 patients and included

* cranial (n = 4)

* spinal (n = 2)

* cerebrospinal fluid (CSF) switch insertion (n = 7), and

* CSF switch revision (n = 16) procedures

common patient received a central venous catheter, three received peripheral arterial catheters, and four underwent novel antimicrobial therapy.

Vancomycin was administered as a prophylaxis for cranial (n = 4) spinal (n = 2) and switch (n = 22) procedures. The first dose was administered to 22 of the patients six minutes to united hour before the surgical management Six patients received vancomycin after the incision was made. couple patients received vancomycin as empiric therapy for suspected meningitis, and no patients received vancomycin as a specific directed therapy based upon positive culture results.

According to HICPAC, 28 of these patients received vancomycin as routine surgical prophylaxis. pair were treated empirically for suspected meningitis. The number of extra doses of vancomycin ranged from undivided to 11, for a total of 50 doses.

Discussion. Vancomycin is an important antimicrobial agent in the treatment of infections caused through gram-positive bacteria. Inappropriate use, however, contributes to a often bigger health risk--VRE. Furthermore, the fresh isolation of strains of Staphylococcus aureus with intermediate resistance to vancomycin may be a warning sign of glutted resistance in the future. Many other antimicrobials have been used favorably as prophylaxis, including cephalosporins, clindamycin-gentamicin, and ampicillin. Given the risk of the emerging see the verb of vancomycin-resistant strains, other antibiotics for neurosurgical actions must be considered. Researchers of this close attention noted that HICPAC recommendations were difficult to apply to pediatric patients undergoing neurosurgical actions and that future consideration should be given to patient population-specific guidelines.

Conclusion. Decreasing the risk of infections associated with multimedication-resistant organisms by way of reducing overuse and misuse of antimicrobials is a major challenge for clinicians. Implementing clinical guidelines or vancomycin restriction policies may encourage appropriate use of vancomycin.