Investigation of the Efficacy of an Intervention on Vancomycin Use in a Country with High Rate of Vancomycin Prescription: A Before-After Study

Objective The aim of the study was to investigate the efficacy of a reminder for the prescriber at the second key time of antimicrobial prescription on vancomycin use. Methods and Materials This study was conducted in a teaching hospital affiliated to Mashhad University of Medical Sciences, Iran, during a 6-month period. All hospitalized adult patients who received more than 48 hours of vancomycin were included and divided into an intervention and a non-intervention group. The intervention was a reminder to the prescriber in the form of a warning letter attached to the patient medical record at the second key time of the antibiotic prescription, emphasizing the microbiological test results. The primary outcome measure was the number of vancomycin days per patient. Results A total of 24,597 hospitalized adult patients were assessed for eligibility, of whom 1006 met the inclusion criteria. Overall, the rate of vancomycin prescription in preintervention period was 152.3 per 1000 hospitalized adult patients. In the post intervention period, the overall number of vancomycin days decreased significantly, with a reduction from 4342 to 1012 days in the intervention group that was equal to a decline of the mean of vancomycin days per patient from 10.9 to 8.9 days (P = 0.001). Conclusions Our study showed the effectiveness of an intervention in the form of a reminder at the second key time of antibiotic prescription in decreasing the overall number of vancomycin days and a mean of vancomycin days per patient. Despite this, there was still a high rate of overuse of vancomycin in the intervention group in postintervention period; a finding that emphasizes the importance and needs of root cause analysis of the factors associated with antibiotic prescription behaviors despite implementation of interventions in the future studies.