Background: Inappropriate IV vancomycin prescribing for febrile neutropenia (FN) is an excellent stewardship target given well-established guidelines specifying indications for its use. As a supplement to an educational initiative with institutional FN guidelines, we conducted methicillin-resistant Staphylococcus aureus (MRSA) colonization screening to estimate its prevalence on our hematology/oncology unit. We hypothesize that MRSA prevalence data can augment existing stewardship efforts to improve IV vancomycin use in FN.
1) Pre-intervention: we conducted a retrospective chart review of vancomycin receipt for FN on a 32-bed Hematology/Oncology unit, 11/2015-5/2016 (control group)
2) Intervention: in 1/2017, we implemented an institutional FN guideline with recurring education to hematology/oncology providers emphasizing criteria for appropriate vancomycin initiation. Vancomycin audit was again conducted from 2/2017-10/2017 (intervention group). The primary outcome was appropriateness of vancomycin use per guideline indications (chi-squared analysis). Use was considered inappropriate if no guideline indications were met.
3) MRSA screening: cultures were obtained from the nares, axilla and groin on admission and bimonthly for 6 weeks and plated on CHROMagar. Screened patients were followed for 5 months for the occurrence of clinical MRSA infection.
Results: Forty-three of 88 controls were started on vancomycin appropriately versus 60 of 91 intervention group patients (49% vs. 66%, p=0.02). Results of MRSA screening and follow-up for invasive infection are shown in table 1.
Conclusion: Recurring, guideline-focused education can improve appropriateness of vancomycin for FN. High NPV in our study supports the hypothesis that MRSA screening can augment stewardship efforts to reduce vancomycin use when not indicated.
A. Binder, None
K. Cowman, None
C. Sheridan, None
Y. Guo, None
M. Levi, None
W. Szymczak, None
P. Gialanella, None
P. Nori, None
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