Reduced Intravenous Vancomycin Use and Cost Savings in a Pediatric Hemodialysis Unit: A Quality Report

Introduction: Intravenous (IV) vancomycin is used in patients receiving chronic hemodialysis (HD) for the treatment of central venous catheter–related infections. Excessive use of IV vancomycin leads to high costs and an increase in multidrug-resistant organisms. Our primary aim was to reduce IV vancomycin use for suspected central venous catheter–related infections in our pediatric chronic HD unit by 50% within 1 year. Our secondary aim was to reduce the total cost of IV vancomycin use by 50%. Methods: With a quality improvement framework, the key interventions include (1) provider education on antibiotic stewardship, related to IV vancomycin and its associated risks; (2) identification of alternative topical/enteral antibiotics; (3) development and implementation of an exit-site scoring tool; and (4) development of a treatment-based algorithm to standardize choice of antibiotic related to exit-site score. Results: We used a statistical process control chart to demonstrate that IV vancomycin use declined from an average of 24 doses per 1,000 patient-days in the preintervention period (August 1, 2018, to August 31, 2019) to 5.1 vancomycin doses per 1,000 patient-days in the postintervention period (September 1, 2019, to July 31, 2020). Additionally, the IV vancomycin cost decreased from $81,297 per 1,000 patient-days during the preintervention period to $14,053 per 1,000 patient-days during the postintervention period. Conclusions: A stepwise incorporation of interventions, including education, the development of a novel exit-site scoring tool, and a treatment-based algorithm, resulted in a 78% decrease in IV vancomycin use in our pediatric chronic HD unit within 1 year and an 82% decrease in associated costs.