Appropriateness of Vancomycin Use in the Emergency Department

Byline: Seth W Wright, Keith D Wrenn Abstract: Study objective: The emergence of vancomycin-resistant organisms is a major problem at many hospitals. Vancomycin use is associated with development of resistance. The objective of this study was to determine the appropriateness of vancomycin use in the emergency department. In addition, we sought to determine whether appropriateness of vancomycin use increased after the publication of the Centers for Disease Control and Prevention guidelines for prudent vancomycin use. Methods: This retrospective study was conducted at a tertiary care university hospital, and all patients who received vancomycin while in the ED during the first 6 months of each year from 1995-1997 were eligible for study. We developed appropriateness criteria based on national and local guidelines. Vancomycin use was determined to be appropriate or inappropriate according to these guidelines. Results: Vancomycin use increased each year of the 3-year study period; 40% of use was considered inappropriate. However, appropriateness increased in a linear fashion (P Article History: Received 12 February 1998; Revised 4 May 1998; Accepted 12 May 1998 Article Note: (footnote) [star] From the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN., [star][star] Address for reprints: Seth W Wright, MD, MPH, 703 Oxford House, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 27232, E-mail seth.wright@mcmail.vanderbilt.edu., a 0196-0644/98/$5.00 + 0 47/1/93443