Financial Burden of Inappropriate Vancomycin Use for Patients With Cancer
Abstract
Background: As an antibiotic, vancomycin presents numerous benefits in controlling methicillinresistant staphylococcal infections; however, if used inappropriately, it can lead to bacterial resistance in patients. The current study aimed to evaluate the financial burden of inappropriate use of Vancomycin in patients with cancers in selected university hospitals in Shiraz.Methods: This descriptive cross-sectional study was conducted in 2017-2018. The required data were collected using a checklist. In total, 150 adult patients with cancer were selected by the census method. moreover, the t-test, Chi-squared test, and Analysis of Variance (ANOVA) were used to examine the relationship between the study variables where appropriate.Results: The present study results suggested that inappropriate prescribing of vancomycin had a frequency of 61 (59.2%) in Namazi Hospital and 22 (46.8%) in Amir Hospital; thus, there was no significant difference between these hospitals concerning the types of prescriptions (P=0.15). It was also found that the inappropriate use of vancomycin cost the patients $1974.2 and $1046.5 in Namazi and Amir hospitals, respectively.Conclusion: The present study data indicated that the most frequent problems were the inappropriate prescription of vancomycin in hematology wards, the lack of drug discontinuation at the proper time, and the continuation of drug administration more than the patients’ needs. Thus, conducting regular educational programs for physicians per relevant guidelines could help reduce unreasonable administration of the drug and the financial burden imposed on patients.
[1] Hajebi G, Mortazavi SA, Godarzi J. [A survey of consumption pattern of antibiotics in Taleghani Hospital (Persian)]. Research in Medicine. 2005; 29(2):157-64. https://pejouhesh.sbmu.ac.ir/article-1-140-en.html
[2] Zareshahi R, Haghdoost AA, Asadipour A, Sadeghirad B. [Rational usage of drug indices in the prescriptions of Kerman medical practitioners in 2008 (Persian)]. J Rafsanjan Univ Med Sci. 2012; 11(6):523-36. http://journal.rums.ac.ir/article-1-1606-en.html
[3] Llor C, Bjerrum L. Antimicrobial resistance: Risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014; 5(6):229-41. [DOI:10.1177/2042098614554919] [PMID] [PMCID]
[4] Khoshdel A, Panahandeh G. [The pattern of antimicrobial utilization in patients of pediatric wards in Hajar hospital, Shahrekord, Iran in 2009-2010 (Persian)]. J Shahrekord Univ Med Sci. 2012; 14(5):54-62. http://journal.skums.ac.ir/browse.php?a_id=1025&sid=1&slc_lang=en
[5] Hosseinzadeh F, Sadeghieh Ahari S, Mohammadian-erdi A. [Survey the antibiotics prescription by general practitioners for outpatients in Ardabil City in 2013 (Persian)]. J Ardabil Univ Med Sci. 2016; 16(2):140-50. http://jarums.arums.ac.ir/browse.php?a_code=A-10-607-15&slc_lang=en&sid=1
[6] Barari M, Afrasiabian S, Mohsenpour B, Hajibagheri K, Sheikhesmaili F. [Evaluation of appropriate antibiotic administration by general practitioners at the emergency department of a teaching hospital in Sanandaj, Iran (Persian)]. Sci J Kurdistan Univ Med Sci. 2018; 23(3):67-72. https://sjku.muk.ac.ir/article-1-4268-en.html
[7] Shabanian A, Karimi Nasab MH, Shayesteh Azar M, Esmaeilnezhad Ganji SM. Type and rate of prophylactic antibiotic use in the orthopedic patients underwent elective surgeries in Shahid Beheshti Hospital in Babol. J Babol Univ Med Sci. 2018; 20(5):68-73. http://jbums.org/browse.php?a_id=7407&sid=1&slc_lang=en
[8] Hatam N, Askarian M, Moravveji AR, Assadian O. Economic burden of inappropriate antibiotic use for prophylactic purpose in Shiraz, Iran. Iran Red Crescent Med J. 2011; 13(4):234-8. [PMID] [PMCID]
[9] Moradi G, Gouya MM, Eshrati B, Mohraz M, Molaei L, Piroozi B. National action plan of the Islamic Republic of Iran for combating antimicrobial resistance during 2016-2021. Med J Islam Repub Iran. 2018; 32:82. [DOI:10.14196/mjiri.32.82] [PMID] [PMCID]
[10] Zarezade M, Shaterzade F, Abedini S, Raadabadi M. [Evaluating pattern of prescribing antibiotics in surgical wards of Shahid Rahnemon Hospital compared to standard methods in 2015 (Persian)]. J Shahid Sadoughi Univ Med Sci. 2015; 23(7):679-90. http://jssu.ssu.ac.ir/browse.php?a_id=3250&sid=1&slc_lang=en
[11] Loeffler JM, Garbino J, Lew D, Harbarth S, Rohner P. Antibiotic consumption, bacterial resistance and their correlation in a Swiss University Hospital and its adult intensive care units. Scand J Infect Dis. 2003; 35(11-12):843-50. [DOI:10.1080/00365540310016646] [PMID]
[12] Hadavand F, Farkhonde S, Motamed N. [Study on observing the indications of vancomycin use in the surgical wards of Shohada Khalij Hospital of Bushehr in 2013 (Persian)][PhD dissertation]. Bushehr: Bushehr University Of Medical Sciences; 2013.
[13] Bunnell KL, Danziger LH, Johnson S. Economic barriers in the treatment of clostridium difficile infection with oral vancomycin. Open Forum Infect Dis. 2017; 4(2):ofx078. [DOI:10.1093/ofid/ofx078] [PMID] [PMCID]
[14] Chiu CH, Michelow IC, Cronin J, Ringer SA, Ferris TG, Puopolo KM. Effectiveness of a guideline to reduce vancomycin use in the neonatal intensive care unit. Pediatr Infect Dis J. 2011; 30(4):273-8. [DOI:10.1097/INF.0b013e3182011d12] [PMID]
[15] Hammer BM, Lardieri AB, Morgan JA. Appropriate use of vancomycin in NICU despite free-for-all policy. J Pediatr Pharmacol Ther. 2016; 21(3):207-12. [DOI:10.5863/1551-6776-21.3.207] [PMID]
[PMCID]
[16] Salehifar E, Babamahmoodi F, Alikhani A, Ganji R, Fazli M. Drug utilization evaluation of vancomycin in a referral infectious center in Mazandaran Province. J Pharm Care. 2014; 2(2):55-9. https://jpc.tums.ac.ir/index.php/jpc/article/view/46
[17] Nateghian AR, Robinson J, Samadi B, Abdi N. Appropriate use of vancomycin in an educational tertiary care hospital in Tehran, Iran. Med J Islam Repub Iran. 2007; 21(1):43-9. http://mjiri.iums.ac.ir/
article-1-274-en.html
[18] Askarian M, Assadian O, Safaee GR, Golkar A, Namazi S, Movahed MR. Vancomycin use in a large teaching hospital in Shiraz, Islamic Republic of Iran, 2003. East Mediterr Health J. 2007; 13(5):1195-201. [DOI:10.26719/2007.13.5.1195] [PMID]
[19] Mahmoodian A, Abbasi S, Farsaei S. A new approach to Vancomycin utilization evaluation: A cross-sectional study in intensive care unit. J Res Pharm Pract. 2016; 5(4):279-84. [DOI:10.4103/2279-042X.192453] [PMID] [PMCID]
[20] Alfandari S, Levent T, Descamps D, Hendricx S, Bonenfant C, Taines V, et al. Evaluation of glycopeptide use in nine French hospitals. Med Mal Infect. 2010; 40(4):232-7. [DOI:10.1016/j.medmal.2009.10.019] [PMID]
[21] de Melo DO, Sasaki M, Grinbaum RS. Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: Comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC). Braz J Infect Dis. 2007; 11(1):53-6. [DOI:10.1590/S1413-86702007000100014] [PMID]
[22] Wright SW, Wrenn KD. Appropriateness of vancomycin use in the emergency department. Ann Emerg Med. 1998; 32(5):531-6. [DOI:10.1016/S0196-0644(98)70030-7] [PMID]
[23] Fahimi F, Soleymani F, Tavakoli-Ardakani M. Vancomycin utilization evaluation in a teaching hospital: A case- series study in Iran. J Pharm Care. 2013; 1(2):51-4. https://jpc.tums.ac.ir/index.php/jpc/article/view/12
[24] Ayazkhoo L, Mousavi S, Ramazani F, Ayatollahi-Tafti M, Sa’dabadi Z, Sistanizad M. Vancomycin utilization evaluation: Are we dosing appropriately? J Pharm Care. 2013; 1(4):149-52. https://jpc.tums.ac.ir/index.php/jpc/article/view/33
[25] Keyserling H, Sinkowitz-Cochran RL, Harris JM, Levine GL, Siegel JD, Stover BH, et al. Vancomycin use in hospitalized pediatric patients. Pediatrics. 2003; 112(2):e104-11. [DOI:10.1542/peds.112.2.e104]
[PMID]
[26] Ghasemi A, Habibzadeh Sh. [Vancomycin indications request form effects on its substandard using in Imam Khomeini Hospital (Persian)]. [MD. Dissertation]. Ardabil: Ardabil University Of Medical Sciences; 2011. https://eprints.arums.ac.ir/1824/
[27] 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(1):42-5. [DOI:10.1086/501703] [PMID]
[28] Gillon J, Xu M, Slaughter J, Pentima MCD. Vancomycin use: Room for improvement among hospitalized children. J Pharm Pract. 2017; 30(3):296-9. [DOI:10.1177/0897190016635478] [PMID]
[29] Al-Kofide H, Zaghloul I, Al-Naim L. Pharmacokinetics of vancomycin in adult cancer patients. J Oncol Pharm Pract. 2010; 16(4):245-50. [DOI:10.1177/1078155209355847] [PMID]
[30] Nateghian A, Robinson JL, Arjmandi K, Vosough P, Karimi A, Behzad A, et al. Epidemiology of vancomycin-resistant enterococci in children with acute lymphoblastic leukemia at two referral centers in Tehran, Iran: A descriptive study. Int J Infect Dis. 2011; 15(5):e332-5. [DOI:10.1016/j.ijid.2011.01.006] [PMID]
[31] Sung L, Lange BJ, Gerbing RB, Alonzo TA, Feusner J. Microbiologically documented infections and infection-related mortality in children with acute myeloid leukemia. Blood. 2007; 110(10):3532-9. [DOI:10.1182/blood-2007-05-091942] [PMID]
[2] Zareshahi R, Haghdoost AA, Asadipour A, Sadeghirad B. [Rational usage of drug indices in the prescriptions of Kerman medical practitioners in 2008 (Persian)]. J Rafsanjan Univ Med Sci. 2012; 11(6):523-36. http://journal.rums.ac.ir/article-1-1606-en.html
[3] Llor C, Bjerrum L. Antimicrobial resistance: Risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014; 5(6):229-41. [DOI:10.1177/2042098614554919] [PMID] [PMCID]
[4] Khoshdel A, Panahandeh G. [The pattern of antimicrobial utilization in patients of pediatric wards in Hajar hospital, Shahrekord, Iran in 2009-2010 (Persian)]. J Shahrekord Univ Med Sci. 2012; 14(5):54-62. http://journal.skums.ac.ir/browse.php?a_id=1025&sid=1&slc_lang=en
[5] Hosseinzadeh F, Sadeghieh Ahari S, Mohammadian-erdi A. [Survey the antibiotics prescription by general practitioners for outpatients in Ardabil City in 2013 (Persian)]. J Ardabil Univ Med Sci. 2016; 16(2):140-50. http://jarums.arums.ac.ir/browse.php?a_code=A-10-607-15&slc_lang=en&sid=1
[6] Barari M, Afrasiabian S, Mohsenpour B, Hajibagheri K, Sheikhesmaili F. [Evaluation of appropriate antibiotic administration by general practitioners at the emergency department of a teaching hospital in Sanandaj, Iran (Persian)]. Sci J Kurdistan Univ Med Sci. 2018; 23(3):67-72. https://sjku.muk.ac.ir/article-1-4268-en.html
[7] Shabanian A, Karimi Nasab MH, Shayesteh Azar M, Esmaeilnezhad Ganji SM. Type and rate of prophylactic antibiotic use in the orthopedic patients underwent elective surgeries in Shahid Beheshti Hospital in Babol. J Babol Univ Med Sci. 2018; 20(5):68-73. http://jbums.org/browse.php?a_id=7407&sid=1&slc_lang=en
[8] Hatam N, Askarian M, Moravveji AR, Assadian O. Economic burden of inappropriate antibiotic use for prophylactic purpose in Shiraz, Iran. Iran Red Crescent Med J. 2011; 13(4):234-8. [PMID] [PMCID]
[9] Moradi G, Gouya MM, Eshrati B, Mohraz M, Molaei L, Piroozi B. National action plan of the Islamic Republic of Iran for combating antimicrobial resistance during 2016-2021. Med J Islam Repub Iran. 2018; 32:82. [DOI:10.14196/mjiri.32.82] [PMID] [PMCID]
[10] Zarezade M, Shaterzade F, Abedini S, Raadabadi M. [Evaluating pattern of prescribing antibiotics in surgical wards of Shahid Rahnemon Hospital compared to standard methods in 2015 (Persian)]. J Shahid Sadoughi Univ Med Sci. 2015; 23(7):679-90. http://jssu.ssu.ac.ir/browse.php?a_id=3250&sid=1&slc_lang=en
[11] Loeffler JM, Garbino J, Lew D, Harbarth S, Rohner P. Antibiotic consumption, bacterial resistance and their correlation in a Swiss University Hospital and its adult intensive care units. Scand J Infect Dis. 2003; 35(11-12):843-50. [DOI:10.1080/00365540310016646] [PMID]
[12] Hadavand F, Farkhonde S, Motamed N. [Study on observing the indications of vancomycin use in the surgical wards of Shohada Khalij Hospital of Bushehr in 2013 (Persian)][PhD dissertation]. Bushehr: Bushehr University Of Medical Sciences; 2013.
[13] Bunnell KL, Danziger LH, Johnson S. Economic barriers in the treatment of clostridium difficile infection with oral vancomycin. Open Forum Infect Dis. 2017; 4(2):ofx078. [DOI:10.1093/ofid/ofx078] [PMID] [PMCID]
[14] Chiu CH, Michelow IC, Cronin J, Ringer SA, Ferris TG, Puopolo KM. Effectiveness of a guideline to reduce vancomycin use in the neonatal intensive care unit. Pediatr Infect Dis J. 2011; 30(4):273-8. [DOI:10.1097/INF.0b013e3182011d12] [PMID]
[15] Hammer BM, Lardieri AB, Morgan JA. Appropriate use of vancomycin in NICU despite free-for-all policy. J Pediatr Pharmacol Ther. 2016; 21(3):207-12. [DOI:10.5863/1551-6776-21.3.207] [PMID]
[PMCID]
[16] Salehifar E, Babamahmoodi F, Alikhani A, Ganji R, Fazli M. Drug utilization evaluation of vancomycin in a referral infectious center in Mazandaran Province. J Pharm Care. 2014; 2(2):55-9. https://jpc.tums.ac.ir/index.php/jpc/article/view/46
[17] Nateghian AR, Robinson J, Samadi B, Abdi N. Appropriate use of vancomycin in an educational tertiary care hospital in Tehran, Iran. Med J Islam Repub Iran. 2007; 21(1):43-9. http://mjiri.iums.ac.ir/
article-1-274-en.html
[18] Askarian M, Assadian O, Safaee GR, Golkar A, Namazi S, Movahed MR. Vancomycin use in a large teaching hospital in Shiraz, Islamic Republic of Iran, 2003. East Mediterr Health J. 2007; 13(5):1195-201. [DOI:10.26719/2007.13.5.1195] [PMID]
[19] Mahmoodian A, Abbasi S, Farsaei S. A new approach to Vancomycin utilization evaluation: A cross-sectional study in intensive care unit. J Res Pharm Pract. 2016; 5(4):279-84. [DOI:10.4103/2279-042X.192453] [PMID] [PMCID]
[20] Alfandari S, Levent T, Descamps D, Hendricx S, Bonenfant C, Taines V, et al. Evaluation of glycopeptide use in nine French hospitals. Med Mal Infect. 2010; 40(4):232-7. [DOI:10.1016/j.medmal.2009.10.019] [PMID]
[21] de Melo DO, Sasaki M, Grinbaum RS. Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: Comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC). Braz J Infect Dis. 2007; 11(1):53-6. [DOI:10.1590/S1413-86702007000100014] [PMID]
[22] Wright SW, Wrenn KD. Appropriateness of vancomycin use in the emergency department. Ann Emerg Med. 1998; 32(5):531-6. [DOI:10.1016/S0196-0644(98)70030-7] [PMID]
[23] Fahimi F, Soleymani F, Tavakoli-Ardakani M. Vancomycin utilization evaluation in a teaching hospital: A case- series study in Iran. J Pharm Care. 2013; 1(2):51-4. https://jpc.tums.ac.ir/index.php/jpc/article/view/12
[24] Ayazkhoo L, Mousavi S, Ramazani F, Ayatollahi-Tafti M, Sa’dabadi Z, Sistanizad M. Vancomycin utilization evaluation: Are we dosing appropriately? J Pharm Care. 2013; 1(4):149-52. https://jpc.tums.ac.ir/index.php/jpc/article/view/33
[25] Keyserling H, Sinkowitz-Cochran RL, Harris JM, Levine GL, Siegel JD, Stover BH, et al. Vancomycin use in hospitalized pediatric patients. Pediatrics. 2003; 112(2):e104-11. [DOI:10.1542/peds.112.2.e104]
[PMID]
[26] Ghasemi A, Habibzadeh Sh. [Vancomycin indications request form effects on its substandard using in Imam Khomeini Hospital (Persian)]. [MD. Dissertation]. Ardabil: Ardabil University Of Medical Sciences; 2011. https://eprints.arums.ac.ir/1824/
[27] 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(1):42-5. [DOI:10.1086/501703] [PMID]
[28] Gillon J, Xu M, Slaughter J, Pentima MCD. Vancomycin use: Room for improvement among hospitalized children. J Pharm Pract. 2017; 30(3):296-9. [DOI:10.1177/0897190016635478] [PMID]
[29] Al-Kofide H, Zaghloul I, Al-Naim L. Pharmacokinetics of vancomycin in adult cancer patients. J Oncol Pharm Pract. 2010; 16(4):245-50. [DOI:10.1177/1078155209355847] [PMID]
[30] Nateghian A, Robinson JL, Arjmandi K, Vosough P, Karimi A, Behzad A, et al. Epidemiology of vancomycin-resistant enterococci in children with acute lymphoblastic leukemia at two referral centers in Tehran, Iran: A descriptive study. Int J Infect Dis. 2011; 15(5):e332-5. [DOI:10.1016/j.ijid.2011.01.006] [PMID]
[31] Sung L, Lange BJ, Gerbing RB, Alonzo TA, Feusner J. Microbiologically documented infections and infection-related mortality in children with acute myeloid leukemia. Blood. 2007; 110(10):3532-9. [DOI:10.1182/blood-2007-05-091942] [PMID]
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| Issue | Vol 7 No 1/2 (2021) | |
| Section | Original Article(s) | |
| Keywords | ||
| Antibiotic vancomycin Patients with cancers Prescriptions Inappropriate prescription | ||
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How to Cite
1.
Hatam N, Askarian M, Moradi N. Financial Burden of Inappropriate Vancomycin Use for Patients With Cancer. JPPM. 2021;7(1/2):53-60.
