This is a non-inferiority study evaluating clinical improvement rate when using MRSA nasal swabs to guide discontinuation of vancomycin for empiric coverage for MRSA pneumonia.
Current clinical guidelines recommend including vancomycin in initial empiric therapy if risk factors for MRSA infection are present, or there is a high incidence of MRSA locally. Prolonged exposure to vancomycin, however, has been linked with the risk of vancomycin-associated kidney failure. Studies have reported that a MRSA nasal swab may be used to predict the presence of MRSA pneumonia. Specifically, pneumonia patients with negative MRSA nasal swabs are 95-99% likely to not have pneumonia due to MRSA. There is limited data, however, evaluating the use of a MRSA nasal swab to guide vancomycin therapy. Accordingly, in this study, pneumonia patients in the intervention arm will have empiric vancomycin discontinued following a negative MRSA nasal swab. In the control arm, patients vancomycin will not be discontinued based on the MRSA nasal swab result. The rate of clinical resolution will be compared between these two study arms.
Study Type
OBSERVATIONAL
Enrollment
278
Charleston Area Medical Center
Charleston, West Virginia, United States
Rate of Clinical Improvement
Rate of clinical improvement following 7 days of antibiotic therapy for pneumonia. Clinical improvement rate is defined as the percentage of patients who had clinical documentation of improvement or resolution of all clinical signs and symptoms of pneumonia present at the time of pneumonia diagnosis. * Afebrile: Temperature \<38.0ºC or \<100.4ºF * Improvement of respiratory symptoms and signs per clinical documentation: cough, dyspnea, tachypnea, purulent sputum, increase respiratory secretions, increased suctioning requirements * White blood count (WBC) trending down by at least 25%, or when baseline was≤ 15,000 mm3, or return to the normal values * Less oxygen supplementation and ventilation * Chest radiographic improvement per radiologist report (e.g. infiltrate, consolidation or cavitation)
Time frame: Evaluation will be completed 48 hours after 7 days of antibiotic therapy for pneumonia.
Hospital Length of Stay
Date of admission to date of discharge from the hospital
Time frame: During patient hospital stay for up to 6 months
In-hospital mortality
Number of deaths
Time frame: During patient hospital stay for up to 6 months
Rate of vancomycin-associated kidney injury defined as a 50% increase in serum creatinine or at least two consecutive increases in serum creatinine by 0.5 mg/dL after at least 48 hours of vancomycin therapy.
Number of kidney injuries following administration of vancomycin
Time frame: Time between vancomycin administration and discharge from hospital for up to 6 months.
Hospital complications, such as MRSA bacteremia and septic shock
Number of MRSA bacteremia and septic shock patients whose MRSA nasal swab is negative and have MRSA pneumonia
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Time frame: During patient hospital stay for up tp 6 months
Billing cost associated with vancomycin therapy and laboratory monitoring
Total charges associated with vancomycin therapy and laboratory monitoring
Time frame: During patient hospital stay for up to 6 months