October 23, 2020
A pharmacist-driven protocol for methicillin-resistant Staphylococcus aureus (MRSA) nasal swab polymerase chain reaction (PCR) screening reduced the duration of parenteral vancomycin therapy in patients with lower respiratory tract infection. Researchers reported their findings in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.
The retrospective, multicenter preimplementation and postimplementation study took place at two Mayo Clinic Health System–Southwest Wisconsin Region hospitals. During a preimplementation period from July 8, 2017, through September 30, 2018, pharmacists could order MRSA PCR screening only after a verbal order from a health care provider. During the postimplementation period from October 1, 2018, through January 31, 2019, a collaborative practice agreement allowed pharmacists to order MRSA PCR screening.
During the preimplementation period, 124 out of 241 patients received MRSA PCR screening, with 16.1% receiving a positive MRSA PCR result. During the postimplementation period, 62 of 74 patients received screening, with 14.5% receiving a positive MRSA PCR result.
Compared with a median 24 hours during preimplementation, duration of therapy postimplementation was significantly shorter, at a median 14.3 hours, according to the study.
“In this study, the significant decrease in vancomycin therapy duration was attained without increased rates of adverse clinical outcomes,” researchers reported. “The rates of acute kidney injury were similar between groups. No instances of vancomycin-induced ototoxicity occurred in either group. The rates of 30-day hospital readmission due to lower respiratory tract infection caused by MRSA were similar between groups.”
Woolever NL, Schomberg RJ, Cai S, Dierkhising RA, Dababneh AS, Kujak RC. Pharmacist-Driven MRSA Nasal PCR Screening and the Duration of Empirical Vancomycin Therapy for Suspected MRSA Respiratory Tract Infections. Mayo Clin Proc Innov Qual Outcomes. 2020;4(5):550-556. Published 2020 Aug 15. doi:10.1016/j.mayocpiqo.2020.05.002