The impact of a vancomycin intervention on vancomycin‐associated nephrotoxicity in children: a quality improvement initiative

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Abstract
Background: Vancomycin is first‐line treatment for methicillin‐resistant Staphylococcus aureus (MRSA) infections. However, despite guideline recommendations, there is no evidence that targeting vancomycin trough concentrations of ≥15 mg/L in children confers clinical benefit and is associated with vancomycin‐associated nephrotoxicity (VAN). Aim: This study aimed to evaluate the impact of a vancomycin safety bundle on VAN and vancomycin utilisation in hospitalised paediatric inpatients. Method: A pre–post‐intervention study was conducted in a tertiary paediatric hospital comparing January–December 2018 (pre‐intervention) to May 2019–April 2020 (post‐intervention). Hospitalised children, aged 30 days to Ethical considerations in quality assistance and evaluation activities . Results: A total of 314 vancomycin prescriptions were analysed ( n = 204 pre‐intervention; n = 110 post‐intervention). Post‐intervention, VAN incidence decreased almost twofold from 0.46 to 0.25 episodes per 1000 patient bed days (p ≤ 0.01), and vancomycin prescription days decreased by 19%. Total hospital drug costs for vancomycin decreased by AUD $16 033. Overall, and for paediatric invasive MRSA, no significant difference in clinical outcomes or 30‐day mortality was observed between study periods. Conclusion: This study demonstrated the implementation of a vancomycin safety bundle significantly reduced paediatric VAN and vancomycin utilisation without compromising clinical outcomes. These data support antimicrobial stewardship interventions to improve medication safety for children.

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