Evaluation of vancomycin use in a large university-affiliated hospital in eastern France in 1999

Objective: In 1999, we conducted a retrospective drug utilization review to determine the volume and pattern of vancomycin use in a university-affiliated hospital in eastern France. Methods: Total vancomycin use was determined and expressed as vancomycin courses per 100 admitted patients and defined daily doses (DDD) of vancomycin per 100 patient-days. The indication for vancomycin use was classified as appropriate or inappropriate according to the guidelines issues by the HICPAC. Results: A total of 311 vancomycin courses were given, as 2098 DDD, giving crude incidences of 1.17 courses per 100 admitted patients and of 1.19 defined daily doses per 100 patient-days. The frequency of appropriate courses was 66.7%. Of the 63 inappropriate courses of vancomycin, 39.7% and 28.6% were empiric therapy for nosocomial and community-acquired infections, respectively, 20.6% and 6.3% were specific therapy for nosocomial and community-acquired infections, respectively, and 4.7% were prophylactic. Conclusions: This study shows that vancomycin use in our hospital resulted in a lower selection pressure than has been reported for US university-affiliated hospitals and that comprehensive programs to improve use of vancomycin are needed in our institution.