Impact of rapid discontinuation of empiric vancomycin in patients with HAP or HCAP and absence of respiratory tract cultures Alanna H. Rufe, Linda S. Johnson CHI Memorial - Chattanooga, TN
Background/Purpose: Vancomycin is a recommended empiric therapy for patients with hospital-acquired pneumonia (HAP) and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) or who are at high risk for mortality. Although healthcare-associated pneumonia (HCAP) is excluded in the latest Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) pneumonia guidelines, many clinicians still prefer to use empiric anti-MRSA therapy for this process. De-escalation is encouraged in the guidelines, but clinicians often hesitate to do so in the absence of culture data. Few studies have shown that in certain low-risk patients, vancomycin may not be necessary. A clinical criterion document was developed and implemented at CHI Memorial to facilitate rapid de-escalation of vancomycin when appropriate. This study aims to assess the impact of rapid early discontinuation of vancomycin in patients with HAP or HCAP and no respiratory culture.
Methodology: A retrospective cohort analysis was conducted in adult inpatients who presented with HAP or HCAP with no respiratory culture obtained and at most one pre-determined risk factor for MRSA. Patients who were clinically unstable or worsening at 48 to 72 hours, who were receiving antibiotics for a concomitant infection, or who had a pathogen identified from blood or urinary antigen tests were excluded. The primary endpoint was vancomycin days of therapy pre- and post-intervention. Secondary endpoints include vancomycin re-start within 48 hours, respiratory culture growing MRSA after vancomycin discontinuation, ICU and total length of stay, total days of alternate anti-MRSA therapy and in-hospital mortality in de-escalated vs. non-de-escalated patients.
Results: Pending
Conclusions: Pending
Presentation Objective: Evaluate the impact of a rapid vancomycin discontinuation initiative in patients with HAP or HCAP and inadequate respiratory culture data. `
Self-Assessment: Which of the following is not considered to be a risk factor for MRSA per CHI Memorial's Vancomycin Use Criteria?
