Vancomycin De-Escalation before and after Integration of Prespecified Hold Instructions Based on Mrsa Nasal Pcr Result in the Electronic Medical Record

Document Type

Conference Proceeding

Publication Date

3-6-2026

Publication Title

Am J Health Syst Pharm

Keywords

vancomycin, acute kidney failure, adult, antimicrobial activity, clinical practice, conference abstract, cost benefit analysis, cystic fibrosis, electronic medical record, female, human, incidence, length of stay, major clinical study, male, medical record review, methicillin resistant Staphylococcus aureus, Michigan, observational study, pneumonia, polymerase chain reaction, pregnancy, retrospective study, sepsis, treatment duration

Abstract

Purpose: This study aims to evaluate the impact on vancomycin duration of therapy of implementing a pre-specified methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR)-based hold or discontinuation options in the electronic medical record (EMR) when initiating a pharmacy vancomycin consult in patients with suspected pneumonia or sepsis. MRSA nasal PCR is a well-established tool for antimicrobial de-escalation in clinical practice. The study also aims to assess incidence of acute kidney injury and costs associated with vancomycin dosing and monitoring. Methods: This single-center, pre-post, retrospective observational study was submitted to the Institutional Review Board (IRB) for approval and will be conducted at Henry Ford Health Genesys Hospital in Grand Blanc, Michigan. Adult patients (≥ 18 years) with a pharmacy dosing consult for pneumonia or sepsis from a suspected pneumonia source and MRSA nasal PCR testing are eligible. Exclusion criteria include extrapulmonary infections, pregnancy, cystic fibrosis, use of other anti-MRSA agents besides vancomycin, confirmed growth of MRSA on a culture within the 12 months prior to admission, death or discharge prior to MRSA nasal PCR result or vancomycin administration, and empiric vancomycin use for history of pathogens other than MRSA. The pre-implementation arm will include patients from March to April and July to October of 2024, while the post-implementation arm will include the same periods in 2025. The primary investigator will conduct manual chart reviews to confirm accuracy of provider documentation for infection indication, verify eligibility, and confirm validity of outcome data. The primary outcome is vancomycin duration in days. Secondary outcomes include incidence of AKI (KDIGO criteria), hospital length of stay, same-day discontinuation, re-initiation of vancomycin during the same admission, number of vancomycin levels obtained, and cost analysis using Excel to capture personnel and laboratory expenses. The two arms will be compared using Chi Square (categorical variables) or Student’s T test (continuous variables).

Volume

83

Issue

Supplement_2

First Page

S800

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