Journal article
Emergency Department Vancomycin Use: Dosing Practices and Associated Outcomes
The Journal of emergency medicine, Vol.44(5), pp.910-918
05/2013
DOI: 10.1016/j.jemermed.2012.09.036
PMCID: PMC3637841
PMID: 23260465
Abstract
Background
Emergency Department (ED) dosing of vancomycin and its effect on outcomes has not been examined.
Study Objective
To describe current vancomycin dosing practices for ED patients, focusing on patient factors associated with administration, dosing accuracy based on patient body weight, and clinical outcomes.
Methods
Single-center, retrospective cohort study of vancomycin administered in the ED over 18 months in an academic, tertiary care ED. Data were collected on 4656 patients. Data were analyzed using a generalized estimating equations model to account for multiple doses being administered to the same patient.
Results
The ED dose was continued, unchanged, in 2560 admitted patients (83.8%). The correct dose was given 980 times (22.1%), 3143 doses (70.7%) were underdosed, and 318 were overdosed (7.2%). Increasing weight was associated with underdosing (adjusted odds ratio 1.52 per 10 kg body weight, p < 0.001). Patients who received doses of vancomycin > 20 mg/kg had longer hospital length of stay (p = 0.005); were more likely to spend ≥ 3 days in the hospital (odds ratio [OR] 1.49; 95% confidence interval [CI] 1.12–1.98, p = 0.006); and more likely to die (OR 1.88; 95% CI 1.22–2.90, p = 0.004).
Conclusion
In this largest study to date examining ED vancomycin dosing, vancomycin was commonly given. Dosing outside the recommended range was frequent, and especially prevalent in patients with a higher body weight. The ED dose of vancomycin was frequently continued as an inpatient, regardless of dosing accuracy. There is significant room for improvement in dosing accuracy and indication. Vancomycin dosing in the ED may also affect clinical outcomes.
Details
- Title: Subtitle
- Emergency Department Vancomycin Use: Dosing Practices and Associated Outcomes
- Creators
- Brian M Fuller - Division of Emergency Medicine, Department of Anesthesiology, Division of Critical Care, Washington University School of Medicine, St. Louis, MissouriNicholas Mohr - Department of Emergency Medicine, Department of Anesthesia, Division of Critical Care, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IowaLee Skrupky - Department of Pharmacy, Barnes Jewish Hospital, St. Louis, MissouriKristen Mueller - Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MissouriCraig McCammon - Department of Pharmacy, Barnes Jewish Hospital, St. Louis, Missouri
- Resource Type
- Journal article
- Publication Details
- The Journal of emergency medicine, Vol.44(5), pp.910-918
- DOI
- 10.1016/j.jemermed.2012.09.036
- PMID
- 23260465
- PMCID
- PMC3637841
- NLM abbreviation
- J Emerg Med
- ISSN
- 0736-4679
- eISSN
- 2352-5029
- Publisher
- Elsevier Inc
- Grant note
- name: NIH/NCRR Washington University-ICTS, award: UL1 RR024992
- Language
- English
- Date published
- 05/2013
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984025256302771
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