2017年 AJIC に発表された、 VA Boston Healthcare SystemにおけるMRSA保菌と長期VCM使用との関連性を後ろ向き調査した報告。
Excessive prescribing of vancomycin among patients admitted to inpatient wards is a challenge for antimicrobial stewardship programs, especially in the setting of expanded screening programs for methicillin-resistant Staphylococcus aureus (MRSA). Studies examining factors associated with longer duration of vancomycin use are limited.
First, we were not able to evaluate other clinical factors that may have driven vancomycin use, such as recent health care exposure, β-lactam allergy, severity of disease, or other comorbidities and exposures that may have increased the risk of an MRSA infection.
Second, we were not able to evaluate the impact of the difference between a culture negative for MRSA and a culture that was not performed. Patients without clinical cultures may have fundamentally different diagnoses (eg, nonpurulent cellulitis) and therefore may have a different baseline risk of MRSA infections when compared with patients who did have clinical cultures taken.
Finally, our results are from a single inpatient VA health care system and therefore may not be applicable to other clinical settings, including outpatient parenteral antimicrobial therapy programs. Fortunately, we were able to evaluate a large cohort over multiple years and within an integrated health care system