Why Vancomycin Is Overly Prescribed Despite the Lack of Supporting Microbiological Data: To Design a Concept Map

Objective To develop a concept map in order to evaluate the factors associated with continuing of vancomycin after 48 to 72 hours of prescription despite the lack of supporting microbiological data. Methods This study was conducted in a teaching hospital affiliated to Mashhad University of Medical Sciences, Iran, between January 2017 and March 2017. After demonstrating the high rate of overuse and inappropriate use of vancomycin in our teaching hospital in the first arm of the study, we attempted to evaluate the factors associated with this behavior by developing a concept map. In this study, cluster approach of concept mapping was used and the importance of statements was scored by using the 5-point Likert method (1 for the lowest score and 5 for the highest score). Results Twenty-one physicians were participated, with a male to female ratio of 2. During the brainstorming session, about 25 statements were generated, which eventually resulted in sorting of 16 appropriate statements. The highest scored statements for continuing vancomycin after 48 to 72 hours of prescription in the absence of supporting microbiological data was worries and concerns of physicians regarding critically ill status of patients (score, 3.76) and lack of updated information on microbiological spectrum and antimicrobial resistance pattern of infections at the regional level (score, 3.57). In the final cluster analysis, the mean of importance of a cluster consisted of "health care system-physician related factors"was scored highest (score, 3.2), as compared with other created clusters. Conclusions According to the result of our study, improving vancomycin use requires more effective education of basic principles of diagnosis of infectious clinical syndromes and the concept of deescalation of antibiotics. It should also address physicians' concerns about the management of critically ill septic patients. In addition, providing the physicians with updated information on microbiological spectrum and antimicrobial resistance pattern of infections at the regional level can be effective in improving vancomycin prescription behavior.