1076. Antimicrobial Stewardship Program Achieves Marked Decrease in the use of Vancomycin in a Veterans Hospital

Abstract

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA)is the most common nosocomial infection worldwide. Infection control measures using molecular tests [polymerase chain reaction (PCR) on nares swabs] aid to prevent hospital transmission of MRSA. Nares screening for MRSA has proven to be a valuable tool for antimicrobial stewardship programs (ASP) to de-escalate empiric anti-MRSA therapy in patients with pneumonia (community/nosocomial acquired) not nasally colonized with MRSA. In January 2016, an ASP was initiated at our institution with emphasis on rational use of antibiotics, decrease antibiotic duration and timely de-escalation of all empiric antibiotics, including IV vancomycin using nares PCR for MRSA.MethodsWe compared the vancomycin use at the Northport Veterans Affairs Medical center by days of therapy/1,000 patient-days from 2011–2015 to 2016–2019. Screening for MRSA is by DNA PCR (Cepheid GeneXpert Infinity). ASP reviewed all restricted antibiotic requests via electronic consults and rendered approval or disapproval. In addition, ASP requested empiric vancomycin to be discontinued for patients hospitalized for pneumonia, if PCR was negative for MRSA; PCR results were available within 24hours of admission.ResultsThere were 21,330 admissions (including ICU) from March 1, 2011 to February 28, 2019. Since initiation of ASP in 2016, 4,021 total antibiotic approvals were requested and 483 were denied. 484 IV Vancomycin were requested and 43 were denied. There has been a statistically significant decrease in vancomycin use from 2011–2015 vs. 2016–2019, median by quarter (year divided in 4 quarters) 250 vs. 233, P = 0.012; Comparing the same time periods there has been a decrease in positive MRSA nares screening upon admission median annual rate 354 vs. 220, P = 0.011. There was no difference in vancomycin-resistant enterococci in clinical isolates, median 16 vs. 14.5, P = 0.465. Inpatient infectious diseases consultations increased by 30% since ASP was initiated.ConclusionOur ASP was successful in decreasing use of vancomycin through both disapproval of medication when a request was deemed inappropriate, and by promoting de-escalation of therapy by the use of MRSA nares screening in patients who were started empirically on MRSA antibiotic therapy for pneumonia. Disclosures All authors: No reported disclosures.