1939. Assessing the Impact of a Pharmacist-managed Vancomycin Protocol on the Duration of Empiric Therapy
Session: Poster Abstract Session: Antibiotic Stewardship: Pharmacist Led Interventions
Saturday, October 29, 2016
Room: Poster Hall
Background: A pharmacist-managed vancomycin protocol (VP) allows for timely vancomycin de-escalation or discontinuation based on negative cultures for methicillin-resistant Staphylococcus aureus(MRSA) and faster achievement of therapeutic troughs. The purpose of this study was to evaluate the impact of a pharmacist-managed VP on the duration of empiric therapy, number of troughs, achievement of target vancomycin level and rate of antimicrobial optimization following cultures.

Methods: A three-phase, retrospective, quasi-experimental study was conducted from September 2014 – December 2014 (pre-protocol); February 2015 – May 2015 and September 2015 – December 2015 (post-protocol). Subjects from each period were matched based on their services at hospital admission (hospital medicine, general surgery, neurosurgery, and orthopedics). Ceftriaxone utilization was described to highlight baseline antibiotic use during the study period.

Results: A total of 310 patients (149 on protocol and 161 off protocol) were analyzed. The median duration of therapy on and off protocol was 3.3 and 3.6 days respectively (p=0.79). The mean number of troughs per patient was significantly reduced from 2.46 off protocol to 2.13 on protocol (p=0.033). There were no significant differences in the number of patients that achieved therapeutic levels in the on and off protocol group in the hospital medicine patients, but in the surgical patients, there was a significant difference (91% versus 67%, p=0.02). The percentage of antimicrobial optimization events was similar between both groups (71% versus 62%, p=0.12).

Conclusion: Although the results did not show a significant difference in the duration of empiric therapy, a pharmacist-managed VP did result in decreased number of troughs and increased percentage of achievement of therapeutic targets. There was a trend towards improved optimization of antimicrobials in the on protocol group. At UCSF Medical Center pharmacists are present on all the medical teams and intervene on every patient on vancomycin, therefore, it may be difficult to measure the sole impact of the pharmacist-managed VP on duration of therapy.

Alexandra M. Hanretty, PharmD1, Sarah B. Doernberg, MD, MAS2 and Alexandra Hilts-Horeczko, PharmD1, (1)University of California San Francisco Medical Center, San Francisco, CA, (2)Division of Infectious Diseases, University of California San Francisco Medical Center, San Francisco, CA


A. M. Hanretty, None

S. B. Doernberg, None

A. Hilts-Horeczko, None

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