APPROPRIATENESS OF VANCOMYCIN USE IN THE EMERGENCY DEPARTMENT

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.