Category: Professional Posters
Purpose: In a prior study, appropriate usage of linezolid and vancomycin in adult inpatients on interprofessional rounding teams with documented respiratory tract infections (RTI) was evaluated. Inappropriate prescribing, as well as overuse of antimicrobials, contributes to antimicrobial resistance. Recommended empiric antibiotic therapy for inpatient community acquired pneumonia (CAP) is either a fluoroquinolone monotherapy or a beta-lactam and macrolide combination therapy. Vancomycin or linezolid should only be utilized when community-acquired methicillin-resistant S. aureus (MRSA) is suspected. The purpose of this study was to determine the results of interprofessional quality improvement measures implemented to reduce unnecessary empiric coverage with vancomycin and linezolid.
Methods: The study was a single-center, retrospective, cohort design. Inclusion criteria included adults (age > 18 years) assigned to an internal medicine teaching service who received > 24 hours of scheduled vancomycin or linezolid for documented upper or lower RTI upon admission. Exclusion criteria included diagnosis of infection other than respiratory in nature and pregnancy. Patients were identified using Theradoc and/or Siemens Pharmacy. The following patient parameters were analyzed: patient demographics, broad-spectrum antimicrobial used, days to therapy, diagnosis, culture results, days from culture results to de-escalation, and cost.
Results: Vancomycin or linezolid were used inappropriately in 48.75% of patients in the control group which lead to unnecessary antibiotic exposure and increased healthcare costs. Following the educational intervention from pharmacy and medical providers to prescribers, correct usage of antibiotic therapy increased from 51.25% to 63.5% (p = 0.14). There was a significant decrease in number of days on inappropriate therapy (212 vs 108, p < 0.001), which resulted in a difference in cost of $3,433.00. To follow guideline-directed therapy, vancomycin and linezolid should be reserved for empiric therapy in patients with a MRSA risk. This medication use evaluation established a baseline for prescribing practices at the health system of interest in the specified subset of patients and practitioners. Limitations of the study include a small study population and cost, which was an estimate.
Conclusion: The intervention was successful in reducing the days of inappropriate antibiotic therapy in patients with RTIs. A decrease in inappropriate prescribing was demonstrated; however, not statistically significant. Vancomycin and linezolid were used empirically for patients who do not require MRSA coverage, identifying an area for improvement within the health system. This exposure to broad-spectrum gram-positive agents puts patients at risk for more resistant organisms in the future. While the total number of days of inappropriate antibiotic therapy decreased and percentage of correct use increased from pre- to post-intervention, these results indicate there is still room for improvement to be made.