Background: Neutropenic Fever (NF) is a common complication for patients on myelosuppressive chemotherapy. Despite guidelines by the Infectious Diseases Society of America (IDSA), however, there is variability in physician compliance. There are limited prior studies assessing compliance in this realm and those studies do not fully assess drivers of poor compliance. Poor compliance can result in increased [...]

Case Presentation: A 67-year-old male was hospitalized for right lower extremity skin abscess with cellulitis complicated by methicillin sensitive Staphylococcus Aureusbacteremia. The patient received piperacillin/tazobactam (pip/taz) and vancomycin over the first 5 days of hospitalization which was de-escalated to cefazolin at discharge.   Thirty-six hours after discharge, the patient was readmitted with expanding area of erythema, [...]

Case Presentation: A 69-year-old woman with metastatic breast cancer, atrial fibrillation (on coumadin) and CKD stage III was admitted after a fall. She was treated for pneumonia with ceftriaxone and azithromycin. On hospital day 2, the patient became encephalopathic, hypotensive and required endotracheal intubation for hypercapneic respiratory failure. Antibiotics were broadened to vancomycin and piperacillin/tazobactam.On [...]

Case Presentation: This patient is a 74-year old male with CAD, HFpEF, HTN, Type 2 DM, CKD3, and obesity admitted for sepsis secondary to bilateral lower extremity purulent cellulitis, complicated by acute decompensated heart failure. He was started on cefepime 2 g twice daily and on vancomycin (vanco), dosed daily by level. After receiving only two doses of vanco 1g, the patient was found to have persistently elevated [...]

Case Presentation: A 54-year-old male was admitted for six weeks of progressive lower extremity weakness and bowel and bladder incontinence. Work-up revealed an epidural abscess at T12-S1 with severe spinal stenosis at L1 and L2. He was started in empiric vancomycin and ceftriaxone before undergoing a T12-L5 hemilaminectomy and abscess drainage. During the surgery, absorbable [...]

Case Presentation: We report a case of vancomycin-induced DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome in a 48-year-old female presenting 6 days after discontinuation of IV vancomycin for the treatment of MRSA bacteremia secondary to right foot cellulitis. She presented with 2 days of painful, diffuse, blanchable, morbiliform rash with palmar petechiae. The [...]

Case Presentation: A 24-year-old man presented with MRSA osteomyelitis of his right tibia two months after suffering an open fracture during a helicopter crash into a mountain. He was started on intravenous vancomycin. The patient did well for thirteen days however then started to have recurrent fever spikes up to 104.9 °F with concurrent sinus [...]

Case Presentation: A 38 year old Hispanic male was admitted to the hospital with a four day history of fever, headache, shortness of breath and intermittent left forearm and abdominal rash. All signs and symptoms appeared during the administration of vancomycin and ceased after a few hours of finishing the infusion. His history was significant [...]

Background: Intravenous vancomycin treatment is often necessary beyond hospitalization. Peripherally inserted central catheters (PICCs) are usually placed for this indication. Whether the less invasive midline catheters (midlines) are safe alternatives for outpatient parenteral antimicrobial therapy (OPAT) with vancomycin is unclear. We compared the safety of midlines and PICCs among patients receiving vancomycin for OPAT. Methods: [...]