Vancomycin Infusion Reaction — Moving beyond “Red Man Syndrome”

Alvarez‐Arango, Santiago; Ogunwole, S. Michelle; Sequist, Thomas D.; Burk, Caitlin M.; Blumenthal, Kimberly G.

doi:10.1056/nejmp2031891

Cited by 41 publications

(32 citation statements)

References 5 publications

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“…For this study, we did not intend to assess adverse effects associated with vancomycin. As such, for the present work, we did not have the full and complete data to report adverse pharmacological effects, such as infusion reaction, anaphylaxis, acute kidney injury, ototoxicity, or Stevens-Johnson syndrome/toxic epidermal necrolysis, subsequent to infusion [14][15][16][17]. While we do not anticipate the incidence of these side effects to differ substantially between the PIIA and index cohorts, physicians administering vancomycin should anticipate and promptly respond to these debilitating and potentially life-threatening complications.…”

Section: Discussionmentioning

confidence: 99%

Quality Initiative for the Administration of Vancomycin Prophylaxis in Penicillin-Allergic Neurosurgery Patients

Borja¹,

Sharma²,

Amendolia³

et al. 2021

Cureus

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IntroductionVancomycin may be used as an alternative perioperative antibiotic for penicillin-allergic patients but follows a different infusion timing. At the institution presented herein, noncompliance with recommended vancomycin infusion timing has been hypothesized to contribute toward increased risk of surgical site infections and avoidable expenditures. The objective of this project was to utilize the Performance Improvement In Action methodology to identify, address, and solve the problem of vancomycin administration timing. MethodologyThis study took place at a multi-hospital, urban academic medical center. The protocol was developed by neurosurgery and anesthesia faculty, advanced practice providers, nursing, and pharmacy. Timing of the following points was recorded: initial order, order release, pharmacy verification, vancomycin infusion, and surgical incision. Fifty consecutive penicillin-allergic patients undergoing neurosurgical intervention were prospectively enrolled. Data comparison was made between the pilot and retrospective review cohorts. ResultsThe pilot cohort achieved correct administration of vancomycin in 100% of cases. Average infusion start time prior to incision increased by 257% (p<0.0001). ConclusionsThis study demonstrates a departmental capacity for optimized timing of vancomycin infusions, in a budget-and workflow-neutral process, while reducing inappropriate administration. In the future, this protocol may be scaled to additional departments and institutions to appropriately and efficiently administer perioperative vancomycin and mitigate the risk for surgical site infections.

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Section: Discussionmentioning

confidence: 99%

Quality Initiative for the Administration of Vancomycin Prophylaxis in Penicillin-Allergic Neurosurgery Patients

Borja¹,

Sharma²,

Amendolia³

et al. 2021

Cureus

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“…After consultation with local experts at our institution, we chose vancomycin flushing syndrome to better reflect the systemic manifestations that may accompany vancomycin infusion. (There continues to be ongoing debate about alternative terms 6 at the time of this publication. )…”

Section: Methodsmentioning

confidence: 99%

Flushing an Offensive Term for Vancomycin Infusion Reaction From the Electronic Medical Record

Konold¹,

Kronman²,

Pak³

et al. 2021

Hospital Pediatrics

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BACKGROUND The medical establishment continues to be complicit in the degradation of native peoples of the United States through the use of the racist phrase “red man syndrome” (RMS) to describe the histamine-release syndrome that accompanies vancomycin infusion. METHODS Five months after the transition from 1 electronic health record to another at our freestanding children’s hospital, our antimicrobial stewardship team reviewed all active allergy records to identify and then replace use of RMS terminology with preferred alternative “vancomycin flushing syndrome.” In partnership with institutional stakeholders, we also launched an educational campaign and instituted in the electronic health record an autocorrect functionality to prevent new RMS entries. RESULTS We identified allergy records for 21 034 individual patients. Vancomycin was an allergen for 445 (2.1%) patients, and RMS-related terminology appeared in 274 (61.6%) of these records; we replaced all RMS instances with the vancomycin flushing syndrome term. During the 3-month period after the intervention, we identified allergy records for 8648 additional patients, with vancomycin as allergen in 65 (0.7%) and with RMS terminology identified and replaced in 29 (44.6%). In addition to the lower rate of RMS among allergy records after the intervention, we detected 3 instances of alternative terminology use. CONCLUSIONS Implementing an institutional-level change in terminology, even for racist language, requires education, reinforcement, and continued surveillance. To effectively replace this term, we need the support of national stakeholders to remove this language from our medical education systems, our textbooks, and our clinical lexicon.

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“…The majority of these patients with delayed large local reactions and those whose cases have been reported elsewhere 3 , 4 have been White. Alvarez-Arango et al 5 note the importance of diverse images of dermatologic findings to mitigate cognitive biases and to better prepare clinicians to recognize and address cutaneous reactions in the diverse patients we serve. We therefore present a case series of delayed large local reactions to messenger RNA (mRNA) vaccines against SARS-CoV-2 in recipients who are Black, Indigenous, or People of Color (BIPOC).…”

mentioning

confidence: 99%

Delayed Large Local Reactions to mRNA Covid-19 Vaccines in Blacks, Indigenous Persons, and People of Color

2021

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Vancomycin Infusion Reaction — Moving beyond “Red Man Syndrome”

Cited by 41 publications

References 5 publications

Quality Initiative for the Administration of Vancomycin Prophylaxis in Penicillin-Allergic Neurosurgery Patients

Quality Initiative for the Administration of Vancomycin Prophylaxis in Penicillin-Allergic Neurosurgery Patients

Flushing an Offensive Term for Vancomycin Infusion Reaction From the Electronic Medical Record

Delayed Large Local Reactions to mRNA Covid-19 Vaccines in Blacks, Indigenous Persons, and People of Color

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