USING METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS SCREENS TO GUIDE VANCOMYCIN ADMINISTRATION

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In June of 2018 an article describing the utility of Methicillin-Resistant Staphylococcus Aureus (MRSA) Nasal Screening to Rule out MRSA Pneumonia was published. Our goal was to incorporate this information into our ICU practice. MRSA Nasal Screen Meta-analysis • CID 2018:67 (1 July) Parente et al. METHODS: For the time period 7/1/2016 to 6/30/2018 we evaluated all nares and groin MRSA screens, and all blood and sputum cultures on our ICU patients. We then calculated the sensitivities (SEN), specificities (SP), positive predictive values (PPV) and negative predictive values (NPV) for patients with respiratory and undifferentiated sepsis diagnoses. When we saw that our NPV were the same as reported, we started ordering nares and groin screens on ICU patients with these diagnoses to help guide vancomycin use. To see if our treatment pattern changed with this information, we compared vancomycin administered from 1/1/2016 to 6/30/2018 with 7/1/2018 to 12/31/2019. We looked at what percentage of patients were treated with vancomycin for more than 2, 3 and 4 days and compared this to the time periods before and after our intervention in July of 2018. We also looked at the average duration of treatment and the average grams of vancomycin administered. All ICU patients, respiratory and undifferentiated sepsis patients were compared. RESULTS: From 7/1/2016 to 6/30/2018 the SEN, SP, PPV, and NPV for nares screens for respiratory diagnoses were 67%, 91%, 10%, and 99% (n=195) and for undifferentiated sepsis were 80%, 9%, 27%, and 99% (n=233). The SEN, SP, PPV, and NPV for groin screens for respiratory diagnoses were 33%, 98%, 25%, and 99% (n=154) and for undifferentiated sepsis were 25%, 95%, 17%, and 97% (n=191). The baseline percentage of patients on vancomycin more than 2, 3, and 4 days were 85%, 71% and 60%. The percentages post intervention were 79%, 59%, and 47%. The percent decrease post intervention for more than 2, 3 or 4 days were 7.1%, 16.9% and 21.7% (p<0.021 for day 2 and p<0.001 for days 3 and 4). Average treatment days decreased from 2.73 to 2.19 (p<.009). While the average total vancomycin administered decreased from 11.24 to 8.70 grams, it did not reach statistical significance. We collected MRSA groin screens for undifferentiated sepsis, but we did not implement a protocol. We did see a decrease in the average total vancomycin administered, 5.08 from 7.04 grams (p<.03), but no change in duration of therapy. When looking at all ICU patients there was no decrease in vancomycin use per day of treatment, average treatment days or grams administered. CONCLUSIONS: Nares and groin MRSA screens can identify patients with respiratory diagnoses who are not infected with MRSA. CLINICAL IMPLICATIONS: They can be used in guiding discontinuation of vancomycin therapy for patients with respiratory diagnoses. DISCLOSURES: Consultant relationship with Monaghan Medical Please note: $1001 - $5000 Added 03/02/2020 by Russell Acevedo, source=Web Response, value=Travel Consultant relationship with Vapotherm Please note: $1001 - $5000 Added 03/02/2020 by Russell Acevedo, source=Web Response, value=Travel Consultant relationship with Fisher & Paycal Please note: $1001 - $5000 Added 03/02/2020 by Russell Acevedo, source=Web Response, value=Grant/Research Support No relevant relationships by Andrea Call, source=Web Response No relevant relationships by Nauman Hamid, source=Web Response No relevant relationships by Viren Kaul, source=Web Response No relevant relationships by David Landsberg, source=Web Response Owner/Founder relationship with Cormac Life Sciences, LLC Please note: $1-$1000 Added 04/08/2020 by Stephen Thomas, source=Web Response, value=Ownership interest Owner/Founder relationship with GreenMark Partners Please note: $1-$1000 Added 04/08/2020 by Stephen Thomas, source=Web Response, value=Ownership interest Advisory Committee Member relationship with Sanofi Pasteur Please note: $20001 - $100000 Added 04/08/2020 by Stephen Thomas, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Takeda Vaccines Please note: $20001 - $100000 Added 04/08/2020 by Stephen Thomas, source=Web Response, value=Consulting fee Advisory Committee Member relationship with PrimeVax Please note: $1-$1000 Added 04/08/2020 by Stephen Thomas, source=Web Response, value=Ownership interest Consultant relationship with Tremeau Pharm Please note: $1001 - $5000 Added 04/08/2020 by Stephen Thomas, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Merck Please note: $1001 - $5000 Added 04/08/2020 by Stephen Thomas, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Moderna Please note: $1-$1000 Added 04/08/2020 by Stephen Thomas, source=Web Response, value=Consulting fee