Can we balance resource utilization and antimicrobial stewardship?

Reviewed by Cindy Noyes, MD, University of Vermont Medical Center

Bottom line: Use of daptomycin in lieu of vancomycin may reduce cost and adverse effects compared to vancomycin. Should stewardship of these resources be included when considering antimicrobial selection?

Wagner and colleagues conducted a multi-center, retrospective cost minimization study that involved 4 hospitals in the southeast US. All adult hospitalized patients who received at least 1 dose of intravenous (IV) vancomycin between January 1, 2017 and July 31, 2021 were included in the analysis. Each site contributed at least 50 patients, randomly selected. Patients who received vancomycin with an indication for treatment of a respiratory tract infection, central nervous system infection or surgical site infection prophylaxis were assigned the “vancomycin group”. All others were included in the “daptomycin-eligible group”. All associated costs for providing both daptomycin and vancomycin were determined and included: cost of drug, estimated cost of vancomycin serum concentration, creatine kinase measurement, drug preparation, drug administration, estimated time of pharmacist review, cost of adverse effects related to acute kidney injury (AKI). A total of 239 patients received one dose of IV vancomycin; 144 of which were eligible to receive daptomycin; 95 were not. Among 239 patients, a total of 2369.72 grams of vancomycin was prescribed for 1147 days. Twenty-four patients developed AKI likely associated with vancomycin, with 5 patients experiencing a total of 20 ICU days and 4 patients requiring renal replacement therapy. Total treatment cost for 239 patients to receive vancomycin was $151,495. Total cost of treatment for 144 to receive daptomycin and 95 ineligible daptomycin patients to receive vancomycin was $114,373, resulting in an excess cost of $37,122. This equated to a potential cost savings of 155.32 per patient. Additionally, total pharmacist time was decreased from 120 hours to 45.44 hours. Should antibiotic selection also consider resource utilization in addition to stewardship that focuses on minimizing resistance?

Reference: Wagner J, et al. Counting the cost of daptomycin versus vancomycin in hospitalized patients: A cost minimization analysis. OFID. 2024;

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