September 25, 2023
2 min read
Source/Disclosures
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Disclosures:
The authors report no relevant financial disclosures.
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Key takeaways:
- After a MRSA swab protocol was implemented, antibiotic administration decreased.
- Vancomycin use also decreased significantly following the swab intervention, as well as a 72-hour restriction protocol.
Implementing a pharmacist-driven MRSA nasal-swab ordering protocol, followed by a 72-hour approval protocol, led to a significant reduction in antibiotic administration and vancomycin use, researchers found.
“We identified a high amount of vancomycin use at our medical center based on benchmarking data and trends in utilization over time,” Natasha N. Pettit, PharmD, clinical pharmacy specialist of infectious diseases at UChicago Medicine, told Healio.
Data derived from Pettit NN, et al. Infect Control Hosp Epidemiol. 2023;doi:10.1017/ice.2023.190.
“We investigated why this was the case and found that empiric courses of vancomycin were often longer than necessary, so we targeted stewardship efforts to try to optimize vancomycin prescribing by implementing pharmacist-driven nasal swab screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization and a restriction protocol for durations of therapy lasting longer than 72 hours,” Pettit said.
In previous studies, high MRSA prevalence has been linked with high monthly use of both anti-MRSA and total antibiotics. Experts have also noted rising concerns about vancomycin-resistant pathogens.
Pettit and colleagues performed a single-center, retrospective, quasi-experimental study, evaluating vancomycin use in three periods during which a pharmacy-driven MRSA nasal swab ordering protocol and a vancomycin 72-hour restriction protocol were implemented — pre-MRSA swab protocol from May 1, 2018, to April 30, 2019; post-MRSA swab protocol from May 1, 2019, to Jan. 31, 2020; and post-MRSA swab protocol plus the 72-hour protocol from Feb. 1, 2020, to Jan. 31, 2022.
According to the study, the primary outcome was a change in the standardized antibiotic administration ratio (SAAR) for antibacterial agents for resistant gram-positive infections.
Overall, the study showed that after the MRSA swab protocol was implemented, the SAAR decreased from 1.26 during the year before any intervention to 1.13 (95% CI, 1.16–1.25). Following the 72-hour restriction protocol, the SAAR decreased further to 0.96 (95% CI, 1–1.12).
The study also showed that vancomycin use decreased from 138.9 during the year before any intervention to 125.3 days of therapy per 1,000 patient-days following the implementation of the MRSA swab protocol and to 112.7 following the 72-hour restriction protocol.
Based on these findings, Pettit concluded that “implementing pharmacist-driven stewardship interventions, including MRSA nasal swab ordering and requiring 72-hour approval for vancomycin continuation, can optimize vancomycin prescribing and reduce overall utilization.”
“As this intervention leveraged the oversight of decentralized/nonantimicrobial stewardship pharmacists of vancomycin use directly working with the prescribing providers — this showcases how stewardship programs can/should consider identifying other clinicians to serve as ‘antimicrobial stewardship extenders’ to facilitate appropriate use of antimicrobials.”
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