Scientific Poster Session I - Original Research

Original Research
  Saturday, October 12, 2024
  11:30 AM–01:00 PM

Abstract

Introduction: One-time vancomycin doses in the emergency department (ED) are a common practice in the management of skin and soft tissue infections (SSTI), accounting for 70% of vancomycin use in discharged patients in a previous study. The impact of this practice on clinical outcomes is unknown and it may lead to increased length of stay due to long vancomycin infusion times.

Research Question or Hypothesis: Investigate whether one-time vancomycin doses in a community teaching hospital impact SSTI treatment failure rates in discharged ED patients.

Study Design: This study was a retrospective, single-center, cohort study comparing adult ED patients with SSTI who received a one-time vancomycin dose (VAN) to those who did not receive any vancomycin (NOVAN). Patients were excluded if they were admitted, received more than one vancomycin dose, or were not discharged on oral antibiotics.

Methods: The primary outcome was thirty-day treatment failure defined as re-presentation to the ED for SSTI at the same site as the index encounter with an empiric therapy change, repeat incision and drainage procedure, or hospital admission. Secondary outcomes included ninety-day treatment failure and ED length of stay. Chi-square tests were used for categorical data. T-tests were used for continuous variables. A priori alpha levels were set to 0.05 and analyses were conducted in R 4.3.3.

Results: Thirty-day treatment failure occurred in 16 patients (8.8%, n = 181) in the NOVAN group and 14 (14.7%, n = 95) in VAN group (p = 0.127). Ninety-day treatment failure occurred in 19 patients (10.5%) in NOVAN and 18 (18.9%) in VAN group (p = 0.046). Mean length of stay was 158.5 minutes in NOVAN and 306.2 minutes in VAN group (?=147.7, p <0.001).

Conclusion: This study does not support the use of one-time vancomycin doses to decrease SSTI treatment failure rates in ED patients managed as outpatients and this practice may increase length of stay.

Presenting Author

Bailey Hyland PharmD, BCPS
Scripps Mercy Hospital, San Diego

Authors

Leah Puglisi MS
Scripps Health

Harminder Sikand Pharm.D., FCSHP, FASHP, FCCP
Scripps Mercy Hospital

Andrew Smith Pharm.D., MBA, BCPS, BCCCP