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Emergency Department vancomycin use: dosing practices and associated outcomes
Brian M Fuller1, Nicholas Mohr, Lee Skrupky
1Division of Emergency Medicine, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.
The Journal of Emergency Medicine
|December 25, 2012
Summary
Emergency Department (ED) vancomycin dosing is common but frequently inaccurate, especially in heavier patients. Inaccurate vancomycin dosing in the ED may negatively impact patient outcomes, including hospital length of stay and mortality.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Infectious Diseases
Background:
- Vancomycin dosing in the Emergency Department (ED) and its impact on patient outcomes remain under-examined.
- Current practices for vancomycin administration in ED settings require detailed investigation.
Purpose of the Study:
- To analyze vancomycin dosing practices in the ED, focusing on factors influencing administration.
- To assess the accuracy of vancomycin dosing based on patient body weight.
- To evaluate the association between ED vancomycin dosing and clinical outcomes.
Main Methods:
- A single-center, retrospective cohort study was conducted over 18 months in an academic, tertiary care ED.
- Data from 4656 patients receiving vancomycin in the ED were analyzed.
- A generalized estimating equations model was used to account for multiple doses per patient.
Main Results:
- Vancomycin dosing in the ED was frequently continued unchanged for admitted patients (83.8%).
- Accurate dosing occurred in only 22.1% of cases; 70.7% were underdosed, and 7.2% were overdosed.
- Higher body weight was linked to underdosing (aOR 1.52 per 10 kg, p < 0.001). Doses > 20 mg/kg correlated with longer hospital stays, increased likelihood of ≥ 3 days hospitalization, and higher mortality (aOR 1.88, p = 0.004).
Conclusions:
- This study highlights frequent inaccuracies in Emergency Department vancomycin dosing, particularly underdosing in heavier patients.
- Inaccurate vancomycin dosing in the ED, often continued during inpatient care, appears to be associated with adverse clinical outcomes.
- Improvements in vancomycin dosing accuracy and appropriate indication in the ED are warranted.
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