What is the Primary Driver of Pre-Operative Vancomycin Use? It's Not MRSA-or Allergy.

Factors driving vancomycin surgical prophylaxis are poorly understood. In a national VA cohort with manually validated data, surgical specialty (cardiac, orthopedics) and perception of high facility MRSA prevalence-not MRSA colonization-- were the primary drivers of prescribing. Beta-lactam allergy was the second-most common reason. These data may inform peri-operative stewardship.