Compliance with Institutional Guidelines on the Use of Vancomycin in a Medical Intensive Care Unit

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The University of Michigan implemented guidelines and restrictions for the use of vancomycin in 1995, based on recommendations from the Centers for Disease Control and Prevention. This study evaluated vancomycin use in the University of Michigan's Medical Intensive Care Unit (MICU), and assessed compliance with these institutional guidelines.


The primary objective of the study was to assess compliance with institutional guidelines. All patients admitted to the MICU who received vancomycin during the period of October 2002 through January 2003 were included in the study. Patients were identified retrospectively, and patient medical records were accessed to gather pertinent information. Approval of the Institutional Review Board was obtained.


Fifty-one patients received a total of 71 courses of vancomycin therapy (55 empiric, 16 definitive). Fifty-five (77.5%) of the 71 total courses of vancomycin therapy met institutional criteria. All courses of definitive therapy met specific criteria. Thirty-nine (71%) of the 55 courses of empiric therapy met criteria. Of the courses of empiric therapy which did not fulfill criteria, 12 were from patients exhibiting signs of sepsis and received vancomycin for more than 72 hours, and nine involved immunocompromised patients.


The implementation of guidelines and restrictions is essential to limiting and preventing resistance, but are only effective if designed with the specific hospital's patient population in mind. The results of this study suggest that immunocompromised patients may require a different approach than what is allowed by existing criteria.

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