{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T01:08:01Z","timestamp":1773796081544,"version":"3.50.1"},"reference-count":44,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,8,1]]},"abstract":"<jats:p>Objectives. To assess vancomycin utilization at children\u2019s hospitals, to determine risk factors for vancomycin use and length of therapy, and to facilitate adapting recommendations to optimize vancomycin prescribing practices in pediatric patients.<\/jats:p>\n               <jats:p>Methods. Two surveys were conducted at Pediatric Prevention Network hospitals. The first (Survey I) evaluated vancomycin control programs. The second (Survey II) prospectively reviewed individual patient records. Each hospital was asked to complete questionnaires on 25 consecutive patients or all patients for whom vancomycin was prescribed during a 1-month period.<\/jats:p>\n               <jats:p>Results. In Survey I, 55 of 65 (85%) hospitals reported their vancomycin control policies. Three quarters had specific policies in place to restrict vancomycin use. One half had at least 3 vancomycin restriction measures. In Survey II, personnel at 22 hospitals reviewed 416 vancomycin courses, with 2 to 25 (median = 12) patients tracked per hospital. Eighty-two percent of the vancomycin prescribed was for treatment of neonatal sepsis, fever\/neutropenia, fever of unknown origin, positive blood culture, pneumonia, or meningitis. In an additional 6% (26\/416), vancomycin was prescribed for patients with \u03b2-lactam allergies and in 13% (56\/416) for prophylaxis. Median duration of prophylaxis was 2 days (range: 1\u201315 days). Almost half (196, 47%) of the patients who received vancomycin were in intensive care units; 27% of the vancomycin courses were initiated by neonatologists and 19% by hematologists\/oncologists. The predominant risk factor at the time of vancomycin initiation was the presence of vascular catheters (322, 77%); other host factors included cancer chemotherapy (55, 13%), transplant (30, 7%), shock (24, 6%), other immunosuppressant therapy (17, 4%), or hyposplenic state (2, &amp;lt;1%). Other clinical considerations were severity of illness (96, 23%), uncertainty about diagnosis (51, 12%), patient not responding to current antibiotic therapy (40, 10%), or implant infection (13, 3%). When vancomycin was initiated, blood cultures were positive in 85 patients (20%); cultures from other sites were positive in 45 (11%), and Gram stains of body fluids were positive in 37 (9%). In 29 (7%) patients, organisms sensitive only to vancomycin were isolated before vancomycin initiation. Reasons for discontinuing vancomycin included: therapeutic course completed (125, 30%), negative cultures (106, 25%), alternative antibiotics initiated (75, 18%), illness resolved (14, 3%), or patient expired (13, 3%). Final results of blood culture isolates resistant to \u03b2-lactam antibiotics included 48 coagulase-negative staphylococcus, 5 Staphylococcus aureus, and 10 other species.<\/jats:p>\n               <jats:p>Conclusions. At children\u2019s hospitals, vancomycin is initiated for therapy in patients who have vascular catheters and compromised host factors. Only 7% had laboratory-confirmed \u03b2-lactam-resistant organisms isolated at the time vancomycin was prescribed. Efforts to modify empiric vancomycin use in children\u2019s hospitals should be targeted at intensivists, neonatologists, and hematologists. Initiatives to decrease length of therapy by decreasing the number of surgical prophylaxis doses and days of therapy before laboratory results may decrease vancomycin exposure.<\/jats:p>","DOI":"10.1542\/peds.112.2.e104","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:43:47Z","timestamp":1092444227000},"page":"e104-e111","source":"Crossref","is-referenced-by-count":30,"title":["Vancomycin Use in Hospitalized Pediatric Patients"],"prefix":"10.1542","volume":"112","author":[{"given":"Harry L.","family":"Keyserling","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronda L.","family":"Sinkowitz-Cochran","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, CDC, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"II","given":"James M.","family":"Harris","sequence":"additional","affiliation":[{"name":"NACHRI, Alexandria, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gail L.","family":"Levine","sequence":"additional","affiliation":[{"name":"NACHRI, Alexandria, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane D.","family":"Siegel","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beth H.","family":"Stover","sequence":"additional","affiliation":[{"name":"Kosair Children\u2019s Hospital, Louisville, Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon A.","family":"Lau","sequence":"additional","affiliation":[{"name":"MMP, Inc, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William R.","family":"Jarvis","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, CDC, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the Pediatric Prevention Network","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2003,8,1]]},"reference":[{"key":"2021121003340869600_R1","doi-asserted-by":"crossref","unstructured":"Leclercq R, Derlot E, Duval J, Courvalin P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterocuccus faecium.N Engl J Med.1988;319:157\u2013161","DOI":"10.1056\/NEJM198807213190307"},{"key":"2021121003340869600_R2","doi-asserted-by":"crossref","unstructured":"Uttley AH, Collins CH, Naidoo J, George RC. Vancomycin-resistant enterococci. Lancet.1988;1:57\u201358","DOI":"10.1016\/S0140-6736(88)91037-9"},{"key":"2021121003340869600_R3","doi-asserted-by":"crossref","unstructured":"Boyle JF, Soumakis SA, Rendo A, et al. Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci. J Clin Microbiol.1993;31:1280\u20131285","DOI":"10.1128\/jcm.31.5.1280-1285.1993"},{"key":"2021121003340869600_R4","doi-asserted-by":"crossref","unstructured":"Schwalbe RS, Stapleton JT, Gilligan PH. Emergence of vancomycin resistance in coagulase-negative staphylococci. N Engl J Med.1987;316:927\u2013931","DOI":"10.1056\/NEJM198704093161507"},{"key":"2021121003340869600_R5","doi-asserted-by":"crossref","unstructured":"Raad I, Alrahwan A, Rolston K. Staphylococcus epidermidis: emerging resistance and need for alternative agents. Clin Infect Dis.1998;26:1182\u20131187","DOI":"10.1086\/520285"},{"key":"2021121003340869600_R6","doi-asserted-by":"crossref","unstructured":"Veach LA, Pfaller MA, Barret M, Koontz FP, Wenzel RP. Vancomycin resistance in Staphylococcus haemolyticus causing colonization and bloodstream infection. J Clin Microbiol.1990;28:2064\u20132068","DOI":"10.1128\/jcm.28.9.2064-2068.1990"},{"key":"2021121003340869600_R7","doi-asserted-by":"crossref","unstructured":"Sohn AH, Garrett DO, Sinkowitz-Cochran RL, et al and the Pediatric Prevention Network. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr.2001;139:821\u2013827","DOI":"10.1067\/mpd.2001.119442"},{"key":"2021121003340869600_R8","unstructured":"Centers for Disease Control and Prevention. Reduced susceptibility of Staphylococcus aureus to vancomycin\u2014Japan, 1996. MMWR.1997;46:624\u2013626"},{"key":"2021121003340869600_R9","doi-asserted-by":"crossref","unstructured":"Smith TL, Pearson ML, Wilcox KR, et al. Emergence of vancomycin resistance in Staphylococcus aureus. N Engl J Med.1999;340:493\u2013501","DOI":"10.1056\/NEJM199902183400701"},{"key":"2021121003340869600_R10","doi-asserted-by":"crossref","unstructured":"Whitney CG, Farley MM, Hadler J, et al. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med.2000;343:1917\u20131924","DOI":"10.1056\/NEJM200012283432603"},{"key":"2021121003340869600_R11","unstructured":"Centers for Disease Control and Prevention. Staphylococcus aureus resistant to vancomycin\u2014United States, 2002. MMWR.2002;51:565\u2013567"},{"key":"2021121003340869600_R12","doi-asserted-by":"crossref","unstructured":"Kirst HA, Thompson DG, Nicas TI. Historical yearly usage of vancomycin [letter]. Antimicrob Agents Chemother.1998;42:1303\u20131304","DOI":"10.1128\/AAC.42.5.1303"},{"key":"2021121003340869600_R13","doi-asserted-by":"crossref","unstructured":"Ena J, Dick RW, Jones RN, Wenzel RP. The epidemiology of vancomycin usage in a university hospital. JAMA.1993;269:598\u2013602","DOI":"10.1001\/jama.269.5.598"},{"key":"2021121003340869600_R14","doi-asserted-by":"crossref","unstructured":"Sinkowitz RL, Keyserling H, Walker TJ, Holland J, Jarvis WR. Epidemiology of vancomycin usage at a children\u2019s hospital, 1993 through 1995. Pediatr Infect Dis J.1997;16:495\u2013499","DOI":"10.1097\/00006454-199705000-00006"},{"key":"2021121003340869600_R15","unstructured":"Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee. MMWR Recomm Rep.1995;44(RR-12):1\u201313"},{"key":"2021121003340869600_R16","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics, Committee on Infectious Diseases. Therapy for children with invasive pneumococcal infections. Pediatrics.1997;99;289\u2013299","DOI":"10.1542\/peds.99.2.289"},{"key":"2021121003340869600_R17","doi-asserted-by":"crossref","unstructured":"Goldmann DA, Weinstein RA, Wenzel RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. JAMA.1996;275:234\u2013240","DOI":"10.1001\/jama.275.3.234"},{"key":"2021121003340869600_R18","doi-asserted-by":"crossref","unstructured":"Shlaes DM, Gerding DN, John JF Jr, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: Guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol.1997;18:275\u2013291","DOI":"10.1086\/647610"},{"key":"2021121003340869600_R19","doi-asserted-by":"crossref","unstructured":"Logsdon BA, Lee KR, Leudtke G, Barrett FF. Evaluation of vancomycin use in a pediatric teaching hospital based on CDC criteria. Infect Control Hosp Epidemiol.1997;18:780\u2013782","DOI":"10.1086\/647539"},{"key":"2021121003340869600_R20","doi-asserted-by":"crossref","unstructured":"Hopkins HA, Sinkowitz-Cochran RL, Rudin BA, Keyserling HL, Jarvis WR. Vancomycin use in pediatric hematology-oncology patients. Infect Control Hosp Epidemiol.2000;21:48\u201350","DOI":"10.1086\/501698"},{"key":"2021121003340869600_R21","doi-asserted-by":"crossref","unstructured":"Shah SS, Sinkowitz-Cochran RL, Keyserling HL, Jarvis WR. Vancomycin use in pediatric cardiothoracic surgery patients. Pediatr Infect Dis J.1999;18:558\u2013560","DOI":"10.1097\/00006454-199906000-00019"},{"key":"2021121003340869600_R22","doi-asserted-by":"crossref","unstructured":"Shah SS, Sinkowitz-Cochran RL, Keyserling HL, Jarvis WR. Vancomycin use in pediatric neurosurgery patients. Am J Infect Control.1999;27:482\u2013487","DOI":"10.1016\/S0196-6553(99)70025-8"},{"key":"2021121003340869600_R23","doi-asserted-by":"crossref","unstructured":"Girouard S, Levine G, Goodrich K, et al. Pediatric Prevention Network: A multicenter collaboration to improve health care outcomes. Am J Infect Control.2001;29:158\u2013161","DOI":"10.1067\/mic.2001.115405"},{"key":"2021121003340869600_R24","unstructured":"Dean AG, Dean JA, Coulombier D, et al. Epi-Info Version 6: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Atlanta, GA: Centers for Disease Control and Prevention; 1994"},{"key":"2021121003340869600_R25","doi-asserted-by":"crossref","unstructured":"Mermel LA, Farr BM, Sheretz RJ, et al. Guidelines for the management of intravascular-related infection. Clin Infect Dis.2001;32:1249\u20131272","DOI":"10.1086\/320001"},{"key":"2021121003340869600_R26","doi-asserted-by":"crossref","unstructured":"Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from January 1992-June 2001, Issued August 2001. Am J Infect Control.2001;29:404\u2013421","DOI":"10.1067\/mic.2001.119952"},{"key":"2021121003340869600_R27","doi-asserted-by":"crossref","unstructured":"Lawton RM, Fridkin SK, Gaynes RP, McGowan JE Jr. Practices to improve antimicrobial use at 47 US hospitals: The status of the 1997 SHEA\/IDSA position paper recommendations. Infect Control Hosp Epidemiol.2000;21:256\u2013259","DOI":"10.1086\/501754"},{"key":"2021121003340869600_R28","doi-asserted-by":"crossref","unstructured":"Hamilton CD, Drew R, Janning SW, Latour JK, Hayward S. Excessive use of vancomycin: a successful intervention strategy at an academic medical center. Infect Control Hosp Epidemiol.2000;21:42\u201345","DOI":"10.1086\/501703"},{"key":"2021121003340869600_R29","doi-asserted-by":"crossref","unstructured":"Lin PL, Oram RJ, Lauderdale DS, Dean R, Daum RS. Knowledge of Centers for Disease Control and Prevention guidelines for the use of vancomycin at a large tertiary care children\u2019s hospital. J Pediatr.2000;137:694\u2013700","DOI":"10.1067\/mpd.2000.109113"},{"key":"2021121003340869600_R30","doi-asserted-by":"crossref","unstructured":"Karlowicz MG, Buescher ES, Surka AE. Fulminant late-onset sepsis in neonatal intensive care unit, 1988\u20131997, and the impact of avoiding empiric vancomycin therapy. Pediatrics.2000;106:1387\u20131390","DOI":"10.1542\/peds.106.6.1387"},{"key":"2021121003340869600_R31","unstructured":"Sa\u0301nchez PJ, Mohamed WA, Gard JW, et al. Use of a vancomycin-reduction protocol in a neonatal intensive care unit: what\u2019s the outcome? 37th Annual Meeting of the Infectious Diseases Society of America, Philadelphia, PA, November 1999"},{"key":"2021121003340869600_R32","unstructured":"Sanchez PJ, Rubin LG, Siegel JD, Levine GL, Jarvis WR. Late-Onset Neonatal Sepsis: A Survey of Neonatal Intensive Care Unit (NICU) Practices. Presented at the 2001 Pediatric Academic Societies Annual Meeting, April 29, 2001, Baltimore, MD"},{"key":"2021121003340869600_R33","doi-asserted-by":"crossref","unstructured":"Sohn AH, Jarvis WR. Benchmarking in Pediatric Infection Control: Results from the National Nosocomial Infections Surveillance (NNIS) System and the Pediatric Prevention Network. Semin Pediatr Infect Dis.2001;12:254\u2013265","DOI":"10.1053\/spid.2001.24106"},{"key":"2021121003340869600_R34","doi-asserted-by":"crossref","unstructured":"Anonymous. Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. European Organization for Research and Treatment of Cancer (EORTC) International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada-Clinical Trials Group. J Infect Dis.1991;163:951\u2013958","DOI":"10.1093\/infdis\/163.5.951"},{"key":"2021121003340869600_R35","doi-asserted-by":"crossref","unstructured":"Hughes WT, Armstrong D, Bodey GP, et al. 2002 Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis.2002;34:730\u2013751","DOI":"10.1086\/339215"},{"key":"2021121003340869600_R36","doi-asserted-by":"crossref","unstructured":"Haines SJ, Walters BC. Antibiotic prophylaxis for cerebrospinal fluid shunts: a meta-analysis. Neurosurgery.1994;34:87\u201393","DOI":"10.1227\/00006123-199401000-00012"},{"key":"2021121003340869600_R37","doi-asserted-by":"crossref","unstructured":"Lee KR, Ring JC, Leggiadro RJ. Prophylactic antibiotic use in pediatric cardiovascular surgery: a survey of current practice. Pediatr Infect Dis J.1995;14:267\u2013269","DOI":"10.1097\/00006454-199504000-00004"},{"key":"2021121003340869600_R38","unstructured":"Centers for Disease Control and Prevention. HICPAC\/CDC Guidelines for prevention of intravascular device-related infections. MMWR Recomm Rep.2002;51(RR-10):1\u201326"},{"key":"2021121003340869600_R39","doi-asserted-by":"crossref","unstructured":"Garland JS, Buch RK, Maloney P, et al. Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial. Pediatr Infect Dis J.1995;14:510\u2013516","DOI":"10.1097\/00006454-199506000-00008"},{"key":"2021121003340869600_R40","doi-asserted-by":"crossref","unstructured":"Harbarth S, Samore MH, Lichtenberg D, Carmeli Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation.2000;101:2916\u20132920","DOI":"10.1161\/01.CIR.101.25.2916"},{"key":"2021121003340869600_R41","doi-asserted-by":"crossref","unstructured":"Harrison CJ. Quinupristin\/dalfopristin. Semin Pediatr Infect Dis.2001;12:200\u2013210","DOI":"10.1053\/spid.2001.24095"},{"key":"2021121003340869600_R42","doi-asserted-by":"crossref","unstructured":"Kennedy MJ, Abdel-Rahman SM, Kearns GL. Oxazolidinones: clinical pharmacology and use in the treatment of infections caused by resistant Gram-positive pathogens. Semin Pediatr Infect Dis.2001;12:186\u2013199","DOI":"10.1053\/spid.2001.24094"},{"key":"2021121003340869600_R43","doi-asserted-by":"crossref","unstructured":"Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol.1999;20:247\u2013278","DOI":"10.1086\/501620"},{"key":"2021121003340869600_R44","doi-asserted-by":"crossref","unstructured":"Shojania KG, Yokoe D, Platt R, Fiskio J, Ma\u2019luf N, Bates DW. Reducing vancomycin use utilizing a computer guideline: results of a randomized controlled trial. J Am Med Inform Assoc.1998;5:554\u2013562","DOI":"10.1136\/jamia.1998.0050554"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/112\/2\/e104\/1002483\/pe080300e104.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/112\/2\/e104\/1002483\/pe080300e104.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T10:25:15Z","timestamp":1639131915000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/112\/2\/e104\/63264\/Vancomycin-Use-in-Hospitalized-Pediatric-Patients"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,8,1]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2003,8,1]]},"published-print":{"date-parts":[[2003,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.112.2.e104","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,8,1]]}}}