Study objective: The emergence of vancomycin-resistant organisms is a
major problem at many hospitals. Vancomycin use is associated with dev
elopment of resistance. The objective of this study was to determine t
he appropriateness of vancomycin use in the emergency department. In a
ddition, 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 r
etrospective study was conducted at a tertiary care university hospita
l, 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. W
e developed appropriateness criteria based on national and local guide
lines. Vancomycin use was determined to be appropriate or inappropriat
e according to these guidelines. Results: Vancomycin use increased eac
h year of the 3-year study period; 40% of use was considered inappropr
iate. 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, regardles
s of the appropriateness of drug use, continued to receive vancomycin
after admission. Conclusion: Overall vancomycin use rose each year des
pite an increase in the proportion with appropriate use. However, inap
propriate use remained common. Emergency physicians and consultants sh
ould become familiar with national and local guidelines far prudent va
ncomycin use.