The methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) has a negative predictive value of 95.2-99.2% for MRSA pneumonia. Negative MRSA nasal PCR results can be used as an effective tool to discontinue unnecessary empiric vancomycin therapy.
This single-center, pre-post quasi experimental pilot study evaluated the impact of a pharmacist-led MRSA nasal PCR screening protocol on vancomycin days of therapy (DOT) in patients with pneumonia. All adult patients with IV vancomycin ordered for pneumonia admitted to non-intensive care units were included. Patients who received nasal mupirocin, transitioned to hospice during admission, or had another indication requiring vancomycin were excluded. Pharmacists ordered a MRSA nasal PCR, per protocol, upon order verification. Negative results were used to recommend vancomycin discontinuation when appropriate. Prospective data were compared to a random retrospective cohort during a similar time frame the previous year. The primary outcome was vancomycin DOT before and after protocol implementation. Secondary outcomes included length of stay, quantity of vancomycin levels obtained, in-hospital mortality, acute kidney injury incidence, adherence to the protocol, and need for antimicrobial escalation.
A total of 130 patients were included (n = 65, pre-intervention; n = 65, post-intervention). No statistically significant differences were observed in the demographics between the two groups. The median reduction in vancomycin DOT was 1.4 days [2.9 days (IQR 1.8-4.1) vs 1.5 days (IQR 0.7-2.3); p < 0.001]. The percentage of IV vancomycin ordered for pneumonia was reduced by 5.2% (19.6% vs 14.4%; p = 0.036). The protocol also resulted in a decreased median number of serum vancomycin levels (p < 0.001). No statistically significant differences were observed in the secondary outcomes and there were no adverse clinical outcomes. Protocol adherence was 67.9% overall.
Implementation of a pharmacist-led MRSA surveillance protocol significantly reduced vancomycin days of therapy, reduced serum vancomycin levels, and had no unintended adverse consequences for respiratory tract infections. Results from this pilot project will be used to expand this protocol systemwide.
J. Starykowicz, None
S. M. Wieczorkiewicz, None
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