Appropriateness of vancomycin use in the emergency department

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.

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.

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 <.001). A resistant organism was cultured from 17% of those with appropriate use and none of those with inappropriate use. Most patients, regardless of the appropriateness of drug use, continued to receive vancomycin after admission.

Overall vancomycin use rose each year despite an increase in the proportion with appropriate use. However, inappropriate use remained common. Emergency physicians and consultants should become familiar with national and local guidelines for prudent vancomycin use.