Related Experiment Video
Updated: Jul 21, 2026
A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically
Published on: September 9, 2015
Indications for vancomycin in dialysis patients
T A Golper1, G Schulman, E M D'Agata
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Abstract:
Resistance to vancomycin has emerged among Staphylococcus aureus, coagulase-negative staphylococci (CNS), and enterococci, and this emergence has particular prevalence in dialysis units. It has therefore become imperative that physicians use vancomycin judiciously. General recommendations regarding the appropriate use of vancomycin have been developed. Although in theory implementation of these guidelines should not be difficult, the medical community may be unable or unwilling to make the necessary adjustments in practice. The onslaught of cost constraints and bureaucratic encumbrance has occurred simultaneously with the increase in vancomycin resistance among pathogens commonly isolated among the dialysis population. When a patient responds to empiric antibiotic therapy and susceptibility data indicate that an antibiotic other than vancomycin would be appropriate, the clinician far too often does not make the change to this alternative. Previously there was no biological imperative to change the antibiotic. That complacency has infected an entire generation of physicians, and especially nephrologists. Furthermore, there is an active movement against change, driven by concerns such as malpractice accusations and frank errors in the interpretation of medical facts.
Insights
Physicians, especially nephrologists, are not judiciously using vancomycin, leading to increased resistance in dialysis units. Overcoming complacency and practice barriers is crucial for appropriate antibiotic stewardship.
Area of Science:
- Infectious Diseases
- Nephrology
- Antimicrobial Stewardship
Background:
- Emergence of vancomycin resistance in Staphylococcus aureus, coagulase-negative staphylococci (CNS), and enterococci.
- High prevalence of vancomycin resistance in dialysis units.
- Imperative need for judicious vancomycin use in clinical practice.
Purpose of the Study:
- To highlight the critical need for appropriate vancomycin utilization.
- To address the challenges in implementing vancomycin guidelines.
- To underscore the impact of physician complacency and practice barriers on antimicrobial resistance.
Main Methods:
- Review of current clinical practices regarding vancomycin use in dialysis units.
- Analysis of factors contributing to the inappropriate use of vancomycin.
- Discussion of the implications of physician behavior on antimicrobial resistance patterns.
Main Results:
- Physicians, particularly nephrologists, exhibit complacency in switching from vancomycin to alternative antibiotics even when susceptibility data permits.
- Cost constraints and bureaucratic factors exacerbate the problem of vancomycin overuse.
- Resistance to vancomycin is increasing among pathogens common in dialysis populations.
Conclusions:
- Urgent need for enhanced antimicrobial stewardship programs in dialysis settings.
- Addressing physician complacency and practice inertia is vital to combat vancomycin resistance.
- Revisiting and reinforcing guidelines for vancomycin use is essential to preserve its efficacy.
Related Concept Videos
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:20Estimation of k and VD of Aminoglycosides
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis III: Nursing Management
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention