Category: Federal Forum Posters
Purpose: The primary objective is to assess the effect of vancomycin restriction on duration of therapy of vancomycin in pneumonia patients. We assessed the duration of therapy of vancomycin before and after the implementation of the policy. The secondary objective is to determine the predictive value of MRSA nares surveillance for MRSA pneumonia at VA Long Beach Healthcare System (VALBHS). We evaluated the results of MRSA nares screenings and respiratory cultures in pneumonia patients to assess whether positive or negative nares screening was predictive of MRSA pneumonia.
Methods: This is a retrospective, chart-review, quality-improvement study. Data was collected from the Computerized Patient Record System (CPRS) for patients treated with intravenous vancomycin for pneumonia between July 1, 2017-December 31, 2017 (pre-policy) and July 1, 2018-December 31, 2018 (post-policy). Statistical analysis was performed using chi-square and Mann-Whitney for the primary outcome. The secondary outcome analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR).
Results: 87 patients were included in the study, 44 in the pre-policy group and 43 in the post-policy group. The average duration of therapy of IV vancomycin in the pre-policy group was 5.55 days and 3.7 days in the post-policy group (p=0.02). MRSA nares surveillance at VALBHS has a sensitivity of 88.33% (95% CI 35.88-99.58), specificity of 88.89% (95% CI 75.95-96.26), PPV of 50% (95% CI 28.89-71.11), NPV 97.56% (95% CI 86.95-99.59), PLR 7.5 (95% CI 3.05-18.46), and NLR 0.19 (95% CI 0.03-1.13).
Conclusion: This quality improvement study validated that the vancomycin restriction policy was able to successfully reduce vancomycin utilization. The low PPV indicates that a positive MRSA nares screen has a low likelihood of predicting a positive MRSA pneumonia and should not be used as a tool to determine empirical coverage for MRSA. The high NPV indicates that a negative MRSA nares screen will likely not result in MRSA pneumonia and would be a useful tool to de-escalate therapy.