Indications for vancomycin in dialysis patients

Resistance to vancomycin has emerged among Staphylococcus aureus, coagulase -negative staphylococci (CNS), and enterococci, and this emergence has part icular prevalence in dialysis units. It has therefore become imperative tha t physicians use vancomycin judiciously. General recommendations regarding the appropriate use of vancomycin have been developed. Although in theory i mplementation of these guidelines should not be difficult, the medical comm unity may be unable or unwilling to make the necessary adjustments in pract ice. The onslaught of cost constraints and bureaucratic encumbrance has occ urred simultaneously with the increase in vancomycin resistance among patho gens commonly isolated among the dialysis population. When a patient respon ds to empiric antibiotic therapy and susceptibility data indicate that an a ntibiotic other than vancomycin would be appropriate, the clinician far too often does not make the change to this alternative. Previously there was n o biological imperative to change the antibiotic. That complacency has infe cted an entire generation of physicians, and especially nephrologists. Furt hermore, there is an active movement against change, driven by concerns suc h as malpractice accusations and frank errors in the interpretation of medi cal facts.