Category: Antimicrobial Stewardship: Trends in Antimicrobial Prescribing

Poster Session: Antimicrobial Stewardship: Trends in Antimicrobial Prescribing

227 - Evaluation of Empiric Vancomycin Utilization at 72 Hours Post Admission: is De-escalation of Vancomycin Appropriate?

The ePoster content is available to users who are logged in.<br><br>Please log in and then come back here to use this button.

Presenting Author(s)

Mandana Naderi

Instructor- Antimicrobial Stewardship
University of Arizona College of Pharmacy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

KW

Kimberly Welker

Clinical Pharmacy Specialist- Infectious Diseases
Mercy Gilbert Medical Center
Gilbert, Arizona
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TP

Tina Pourshams-Manzouri

Staff Pharmacist
Chandler Regional Medical Center
Chandler, Arizona
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VH

Vanthida Huang

Professor
Midwestern University, College of Pharmacy-Glendale Campus
Glendale, Arizona
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AB

Amy Buros

Manager of BioClinical Statistics
Midwestern University - Glendale
Glendale, Arizona
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: At both of our institutions in 2018, the average vancomycin days of therapy per 1,000 patient days was 112. The purpose of this study was to examine a 72-hour time-out as an effective de-escalation tool by evaluating the indication and clinical appropriateness of the continuation of empiric vancomycin therapy.

Methods: A retrospective chart review was performed from January 2018 to October 2018 at two community hospitals. Patients > 18 years who received at least 3 days of empiric vancomycin therapy were included. Patients were excluded if immunocompromised, pregnant, on hemodialysis, received vancomycin for surgical prophylaxis, or expired within 72 hours of vancomycin initiation. Criteria for appropriate continuation of vancomycin at 3 days: positive culture for methicillin-resistant Staphylococcus aureus (MRSA), presence of infection with or without defined sources with systemic signs of infection (i.e. white blood cells >12,000 cells/L or < 5,000 cells/L and/or elevated temperature ≥ 37.5°C), or pending wound/sputum cultures after vancomycin initiation.

Results: A total of 160 adult patients initiated on vancomycin were analyzed; 118 of 160 (74%) met appropriate criteria. The most common indications for vancomycin were: skin and soft tissue infections (SSTI) 82 patients (51%); pneumonia 37 patients (23%); and positive blood culture 20 patients (13%). Risk factors for MRSA were similar between both groups. Forty-four (28%) patients had cultures pending and 23 patients (14%) had a known non-MRSA pathogen at time of assessment. American Indian race (OR 3.01 (1.21, 7.53) p-value= 0.0174) and SSTI indication (OR 2.87 (1.24, 6.80) p-value= 0.0147) were associated with not meeting appropriate criteria.Table 1: Baseline Patient Characteristics

Table 2: Vancomycin Indications

Table 3: Multivariate Logistic Regression Model Day 3

Conclusion: Approximately 25% of patients receiving empiric vancomycin therapy did not meet clinical criteria for continuation beyond 72 hours. The indication most commonly associated with continued vancomycin utilization was SSTI. These results identified indications in which empiric vancomycin prescribing can be optimized, and a 72-hour antibiotic time-out may be warranted as a stewardship intervention. Timely culture obtainment and intervention when another pathogen is identified are possible strategies to ensure success of 72-hour time-out.