2003. Vancomycin Discontinuation Is Supported by-negative Nasal Methicillin-Resistant Staphylococcus aureus (MRSA) in Patients with Pneumonia

Abstract

BackgroundA negative nasal MRSA PCR test has a 98–99.6% sensitivity in confirming that MRSA is not the causative organism associated with pneumonia in hospitalized patients. Evidence supporting the clinical utility of nasal MRSA PCR testing in the Veteran patient population is limited, with no identified publications to date. The purpose of this project was to share outcomes associated with implementation of nasal MRSA PCR testing in the Veteran population to guide duration of vancomycin therapy.MethodsThis retrospective cohort quality initiative compared treatment of pneumonia that included vancomycin during a pre-Antimicrobial Stewardship Program (ASP) intervention phase (August 2013–February 2014) to an active ASP intervention phase (August 2017–March 2019). ASP intervention consisted of utilization of a negative nasal MRSA PCR as a rapid diagnostic test to support discontinuation of vancomycin prior to microbiologic culture results. Retrospective chart review evaluated vancomycin days of therapy (DOT), hospital length-of-stay (LOS), 30-day hospital readmission, and 30-day mortality. Patients admitted to the intensive care unit during the identified hospitalization were excluded.ResultsThe average vancomycin DOT significantly declined by 1.08 days when comparing the pre-ASP intervention phase (N = 25) to the ASP-intervention phase (N = 47) (3.6 vs. 2.52 days, respectively; P = 0.0088). Mean hospital LOS decreased by 1.5 days (6.04 vs. 4.54 days, respectively, P = 0.0885). There was no significant difference in 30-day hospital readmission rate (12% vs. 8.5%) or 30-day mortality rate (12% vs. 10%).ConclusionVancomycin DOT was reduced by 30% (1.08 days) and hospital LOS was reduced by 24.8% (1.5 days) in patients with pneumonia during a Vet. Affairs medical center’s utilization of negative nasal MRSA PCR testing to support vancomycin discontinuation. This project highlights the role of nasal MRSA PCR as a rapid diagnostic test to aid in diminishing empiric vancomycin usage and its associated toxicities. Disclosures All authors: No reported disclosures.