Analysis of Vancomycin Therapeutic Drug Monitoring Trends at Pediatric Hospitals

Background: Vancomycin treatment failures in adults with methicillin-resistant Staphylococcus aureus bacteremia are well documented despite established therapeutic monitoring consensus recommendations. Vancomycin use in children has unique challenges, and consensus guidelines are lacking. We evaluated trends in vancomycin monitoring in children and estimated the impact of adult guidelines on patterns of vancomycin use. Methods: A retrospective, descriptive study was designed. Data were obtained from the Pediatric Health Information System from 40 not-for-profit, tertiary care pediatric hospitals in the United States. Patients receiving vancomycin during hospitalizations ending July 1, 2007 through June 30, 2011 were included, and the number of vancomycin monitoring determinations per course of therapy was queried. Vancomycin utilization and monitoring practices were evaluated across institutions, age groups and time intervals. Results: A total of 104,586 patients met study criteria. The mean duration of vancomycin administration was 5 (median 3, range 1-257) days. A mean of 1 (median 1, range 0-186) serum vancomycin concentration was obtained per patient; 46% of patients had none. Eighty-one percent of those receiving vancomycin more than 3 days had monitoring performed at least once. Monitoring practices did not correlate with length of therapy (r(2) = 0.11). Monitoring frequency increased across all age groups (P < 0.05) after publication of adult guidelines in January 2009. Conclusions: Vancomycin monitoring practices are highly variable in children admitted to pediatric hospitals. The frequency with which serum vancomycin concentrations were monitored in children increased after the publication of the adult guidelines. Pediatric consensus guidelines should be developed to optimize patient care and resource utilization.