Descriptive Evaluation of Patients Receiving One-Time Intravenous Vancomycin Doses at a Large Academic Medical Center Emergency Department
Authors: Kyle Schuchter, Donna M Shuler Truoccolo, William S Wilson, Greta Anton
Published in: American Journal of Emergency Medicine, 2023 December 4
Conclusions:
- The one-time administration of IV vancomycin prior to ED discharge, despite its lack of clinical efficacy and potential risks, remains common.
- Opportunities exist for improved antimicrobial stewardship in the ED, focusing on the appropriate use of oral antimicrobials, especially for skin and soft tissue infections, and clarifying antibiotic allergies.
Methods:
- Retrospective, descriptive analysis at a single center (January 2020 - January 2023).
- Examined adult ED patients who received a single dose of IV vancomycin and were discharged without hospital admission.
- Collected data on demographics, comorbidities, vancomycin indications and dosing, ED length of stay (LOS), initial vitals and labs, concurrent antibiotics, culture results, 30-day return visits and admissions, and discharge antibiotics.
Results:
- 295 patients met the inclusion criteria.
- 32.1% met Systemic Inflammatory Response Syndrome (SIRS) criteria.
- "Skin and skin structure infection" was the most common indication (41%).
- 86.1% received concomitant antibiotics in the ED; only 54.6% were prescribed oral antibiotics at discharge.
- 80% had at least one culture obtained: 78.4% had negative cultures, 4.2% had MRSA-positive cultures (most commonly in skin cultures, 3.1%).
- Return ED visits and admissions within 30 days did not significantly differ between patients who did and did not receive oral antibiotics at discharge.