Abstract：
BACKGROUND: Intravenous (IV) vancomycin is commonly used to treat a variety of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). The practice of administering a single dose of IV vancomycin prior to emergency department (ED) discharge may be clinically ineffective and foster antimicrobial resistance. Furthermore, this practice introduces an unnecessary infection risk along with preventable adverse effects while potentially increasing ED length of stay (LOS). There is a paucity of literature identifying patient characteristics and objective findings in this patient population, which may foster future antimicrobial stewardship initiatives in the ED.
METHODS: This was a single-center, retrospective, descriptive analysis of adult patients seen in the ED between January 2020 and January 2023 who received a single dose of IV vancomycin and were subsequently discharged from the ED without hospital admission. Information was collected on patient demographics and select comorbidities, vancomycin indication and dosing, ED LOS, initial vitals and labs, concomitant antibiotics administered, culture results, 30-day return ED visits and admissions, and antibiotics prescribed at ED discharge.
RESULTS: A total of 295 patients met inclusion criteria. A total of 32.1% of patients met SIRS criteria. The most commonly selected order indication for IV vancomycin was \"skin and skin structure infection\" (41%). A total of 86.1% of patients received concomitant antibiotics in the ED and only 54.6% of patients were prescribed oral antibiotics at ED discharge. A total of 80% of patients had at least one culture obtained during the ED visit. In those who had at least one culture obtained, 78.4% of patients had negative cultures and 4.2% of patients had MRSA positive cultures, with MRSA skin cultures being the most common (3.1%). Return ED visits and admissions within 30 days were not statistically significantly different between patients who did and did not receive oral antibiotics at ED discharge.
CONCLUSIONS: Despite a lack of clinical efficacy reported in prior literature and the potential risks, administration of a one-time dose of IV vancomycin prior to ED discharge is commonly encountered in clinical practice. There are opportunities for enhanced antimicrobial stewardship related to IV vancomycin use in the ED. Areas of future focus include the utilization of oral antimicrobials when clinically appropriate, particularly for skin and soft tissue infections, and clarification of antibiotic allergies.
METHODS: This was a single-center, retrospective, descriptive analysis of adult patients seen in the ED between January 2020 and January 2023 who received a single dose of IV vancomycin and were subsequently discharged from the ED without hospital admission. Information was collected on patient demographics and select comorbidities, vancomycin indication and dosing, ED LOS, initial vitals and labs, concomitant antibiotics administered, culture results, 30-day return ED visits and admissions, and antibiotics prescribed at ED discharge.
RESULTS: A total of 295 patients met inclusion criteria. A total of 32.1% of patients met SIRS criteria. The most commonly selected order indication for IV vancomycin was \"skin and skin structure infection\" (41%). A total of 86.1% of patients received concomitant antibiotics in the ED and only 54.6% of patients were prescribed oral antibiotics at ED discharge. A total of 80% of patients had at least one culture obtained during the ED visit. In those who had at least one culture obtained, 78.4% of patients had negative cultures and 4.2% of patients had MRSA positive cultures, with MRSA skin cultures being the most common (3.1%). Return ED visits and admissions within 30 days were not statistically significantly different between patients who did and did not receive oral antibiotics at ED discharge.
CONCLUSIONS: Despite a lack of clinical efficacy reported in prior literature and the potential risks, administration of a one-time dose of IV vancomycin prior to ED discharge is commonly encountered in clinical practice. There are opportunities for enhanced antimicrobial stewardship related to IV vancomycin use in the ED. Areas of future focus include the utilization of oral antimicrobials when clinically appropriate, particularly for skin and soft tissue infections, and clarification of antibiotic allergies.
摘要：
背景：静脉（IV）万古霉素通常用于治疗耐甲氧西林金黄色葡萄球菌（MRSA）引起的多种感染。在急诊科（ED）出院之前施用单剂量的静脉万古霉素的做法可能在临床上无效并促进抗微生物耐药性。此外，这种做法会带来不必要的感染风险以及可预防的不良反应,同时可能会增加ED住院时间(LOS).在该患者人群中，缺乏确定患者特征和客观发现的文献，这可能会促进ED未来的抗菌药物管理计划。
方法：这是一个单中心，回顾性,对2020年1月至2023年1月在ED中观察到的接受单剂量静脉注射万古霉素并随后在没有入院的情况下从ED出院的成年患者进行描述性分析.收集了有关患者人口统计和某些合并症的信息，万古霉素的适应症和剂量，EDLOS,初始生命体征和实验室，同时服用抗生素，文化结果，30天回访ED和入院，和急诊出院时开的抗生素。
结果：共有295例患者符合纳入标准。总共32.1%的患者符合SIRS标准。静脉万古霉素最常选择的顺序适应症是“皮肤和皮肤结构感染”（41％）。共有86.1％的患者在ED中同时使用抗生素，只有54.6％的患者在ED出院时口服了抗生素。总共80%的患者在ED访视期间获得至少一种培养物。在那些获得至少一种文化的人中，78.4%的患者有阴性培养，4.2%的患者有MRSA阳性培养，MRSA的皮肤培养是最常见的（3.1％）。在ED出院时接受和未接受口服抗生素的患者之间，30天内的ED复诊和入院没有统计学上的显着差异。
结论：尽管先前文献报道的临床疗效和潜在风险不足，在ED出院前给予静脉一次剂量的万古霉素是临床实践中常见的。在ED中存在与IV万古霉素使用相关的增强抗菌药物管理的机会。未来的重点领域包括在临床上适当时使用口服抗菌药物，特别是皮肤和软组织感染，和抗生素过敏的澄清。
方法：这是一个单中心，回顾性,对2020年1月至2023年1月在ED中观察到的接受单剂量静脉注射万古霉素并随后在没有入院的情况下从ED出院的成年患者进行描述性分析.收集了有关患者人口统计和某些合并症的信息，万古霉素的适应症和剂量，EDLOS,初始生命体征和实验室，同时服用抗生素，文化结果，30天回访ED和入院，和急诊出院时开的抗生素。
结果：共有295例患者符合纳入标准。总共32.1%的患者符合SIRS标准。静脉万古霉素最常选择的顺序适应症是“皮肤和皮肤结构感染”（41％）。共有86.1％的患者在ED中同时使用抗生素，只有54.6％的患者在ED出院时口服了抗生素。总共80%的患者在ED访视期间获得至少一种培养物。在那些获得至少一种文化的人中，78.4%的患者有阴性培养，4.2%的患者有MRSA阳性培养，MRSA的皮肤培养是最常见的（3.1％）。在ED出院时接受和未接受口服抗生素的患者之间，30天内的ED复诊和入院没有统计学上的显着差异。
结论：尽管先前文献报道的临床疗效和潜在风险不足，在ED出院前给予静脉一次剂量的万古霉素是临床实践中常见的。在ED中存在与IV万古霉素使用相关的增强抗菌药物管理的机会。未来的重点领域包括在临床上适当时使用口服抗菌药物，特别是皮肤和软组织感染，和抗生素过敏的澄清。
