1994. Impact of Pharmacist-initiated MRSA Nasal PCR Protocol on Pneumonia Therapy in a Community Teaching Hospital

Abstract

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) nasal PCR testing can rapidly detect MRSA colonization via nasopharyngeal swab. With a high negative predictive value for MRSA pneumonia, this test may help minimize the duration of anti-MRSA therapy and associated adverse drug events. This study aimed to evaluate the impact of a pharmacist-initiated MRSA nasal PCR protocol on pneumonia therapy in a community teaching hospital.MethodsThis retrospective, quasi-experimental study evaluated adult patients with pneumonia before and after the implementation of a pharmacist-initiated MRSA nasal PCR protocol. The GeneXpert MRSA/SA Nasal Complete Assay was utilized for PCR testing. Prior to protocol implementation the MRSA nasal PCR was not routinely used to assist in pneumonia treatment decisions. Following protocol implementation, pharmacists ordered MRSA PCR testing after an order for anti-MRSA pneumonia therapy; however, prescriber approval was required to discontinue therapy following negative result. The primary outcome of this study was to compare the duration of anti-MRSA therapy between the pre-PCR group (June 1–November 1, 2017) and PCR group (June 1–November 1, 2018). Secondary comparisons included the duration of antipseudomonal therapy, time from IV to PO interchange, adverse events, and clinical outcomes between groups.Results210 patients were included (pre-PCR n = 138, PCR n = 72). Vancomycin was the anti-MRSA therapy ordered for all patients in both groups. In the PCR group, the median time from vancomycin order to PCR order was 2.8 hours (0–45.6 hours), while median time from PCR order to PCR result was 4.4 hours (0.6–31.5 hours). The PCR result was negative for 63 patients (87.5%) and 56 (88.9%) vancomycin orders were discontinued within 24 hours of the negative result. The mean duration of vancomycin therapy was significantly shorter in the PCR group (2.5 vs. 1.4 days, P < 0.001) as well as duration of IV therapy (5 vs. 3.9 days, P = 0.003). There was no difference between groups in duration of antipseudomonal therapy (P = 0.425), acute kidney injury (P = 0.332), 30-day readmission (P = 0.137), or 30-day mortality (P = 0.179).ConclusionA pharmacist-led MRSA nasal PCR protocol significantly decreased the duration of anti-MRSA therapy and IV antibiotic duration in patients with pneumonia.Disclosures All authors: No reported disclosures.