Cargando…

1809. Improved Vancomycin Utilization With Rapidly Available Xpert MRSA/SA BC PCR and Microbiologist Case Review

BACKGROUND: Staphylococcus aureus bloodstream infections are life threatening, and are empirically treated with vancomycin. Our objective was to assess the impact of a rapidly available PCR for methicillin-resistant S. aureus (MRSA) on the amount and duration of vancomycin use in methicillin-sensiti...

Descripción completa

Detalles Bibliográficos
Autores principales: Li, Lisa, Calissi, Piera, Blondel-Hill, Edith, Wang, Bing, Wilmer, Amanda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253897/
http://dx.doi.org/10.1093/ofid/ofy210.1465
_version_ 1783373599615221760
author Li, Lisa
Calissi, Piera
Blondel-Hill, Edith
Wang, Bing
Wilmer, Amanda
author_facet Li, Lisa
Calissi, Piera
Blondel-Hill, Edith
Wang, Bing
Wilmer, Amanda
author_sort Li, Lisa
collection PubMed
description BACKGROUND: Staphylococcus aureus bloodstream infections are life threatening, and are empirically treated with vancomycin. Our objective was to assess the impact of a rapidly available PCR for methicillin-resistant S. aureus (MRSA) on the amount and duration of vancomycin use in methicillin-sensitive S. aureus (MSSA) bloodstream infections. METHODS: In October 2016, the Xpert® MRSA/SA BC assay, a PCR to detect MRSA from blood cultures, was implemented at Kelowna General Hospital. MRSA PCR was performed on one bottle per episode for blood cultures with Gram-positive cocci in clusters in at least 3/4 bottles. The medical microbiologist promptly phoned the most responsible physician with results to streamline antibiotics. All episodes of MSSA bacteremia between January 1, 2013 to September 30, 2016 (pre-implementation group) and November 1, 2016 to January 31, 2018 (post-implementation group), were matched to corresponding vancomycin defined daily doses (DDD) and days of therapy (DOT) in pharmacy records. Patients with ≥5 DOTs were excluded if they had allergies to β-lactams, polymicrobial infections with organisms requiring vancomycin, were on hemodialysis (vancomycin convenience dosing), or were transferred from another hospital with known S. aureus bacteremia. Mean vancomycin DDDs and DOTs, and the proportion of patients receiving at least one dose of vancomycin, were compared between groups. Categorical variables were analyzed using the chi-square test, while continuous variables were compared using the t-test. RESULTS: In the pre-PCR group, 383 episodes of MSSA bacteremia were identified, with 21 excluded. In the post-PCR group, 100 episodes were found, with 3 excluded. Significantly more patients received at least one dose of vancomycin in the pre-PCR (70.2%) compared with the post-PCR group (54.6%) (P < 0.01). The mean DDD was 1.5 in the post-PCR group, less than the pre-PCR group at 2.8 (P < 0.01). The mean DOT also decreased, with the post-PCR group receiving less vancomycin (1.6 days) compared with the pre-PCR group (2.5 days) (P < 0.01). CONCLUSION: Rapidly available MRSA PCR for S. aureus bloodstream infection coupled with antimicrobial stewardship performed by medical microbiologists led to a significant decrease in vancomycin use. DISCLOSURES: All authors: No reported disclosures.
format Online
Article
Text
id pubmed-6253897
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-62538972018-11-28 1809. Improved Vancomycin Utilization With Rapidly Available Xpert MRSA/SA BC PCR and Microbiologist Case Review Li, Lisa Calissi, Piera Blondel-Hill, Edith Wang, Bing Wilmer, Amanda Open Forum Infect Dis Abstracts BACKGROUND: Staphylococcus aureus bloodstream infections are life threatening, and are empirically treated with vancomycin. Our objective was to assess the impact of a rapidly available PCR for methicillin-resistant S. aureus (MRSA) on the amount and duration of vancomycin use in methicillin-sensitive S. aureus (MSSA) bloodstream infections. METHODS: In October 2016, the Xpert® MRSA/SA BC assay, a PCR to detect MRSA from blood cultures, was implemented at Kelowna General Hospital. MRSA PCR was performed on one bottle per episode for blood cultures with Gram-positive cocci in clusters in at least 3/4 bottles. The medical microbiologist promptly phoned the most responsible physician with results to streamline antibiotics. All episodes of MSSA bacteremia between January 1, 2013 to September 30, 2016 (pre-implementation group) and November 1, 2016 to January 31, 2018 (post-implementation group), were matched to corresponding vancomycin defined daily doses (DDD) and days of therapy (DOT) in pharmacy records. Patients with ≥5 DOTs were excluded if they had allergies to β-lactams, polymicrobial infections with organisms requiring vancomycin, were on hemodialysis (vancomycin convenience dosing), or were transferred from another hospital with known S. aureus bacteremia. Mean vancomycin DDDs and DOTs, and the proportion of patients receiving at least one dose of vancomycin, were compared between groups. Categorical variables were analyzed using the chi-square test, while continuous variables were compared using the t-test. RESULTS: In the pre-PCR group, 383 episodes of MSSA bacteremia were identified, with 21 excluded. In the post-PCR group, 100 episodes were found, with 3 excluded. Significantly more patients received at least one dose of vancomycin in the pre-PCR (70.2%) compared with the post-PCR group (54.6%) (P < 0.01). The mean DDD was 1.5 in the post-PCR group, less than the pre-PCR group at 2.8 (P < 0.01). The mean DOT also decreased, with the post-PCR group receiving less vancomycin (1.6 days) compared with the pre-PCR group (2.5 days) (P < 0.01). CONCLUSION: Rapidly available MRSA PCR for S. aureus bloodstream infection coupled with antimicrobial stewardship performed by medical microbiologists led to a significant decrease in vancomycin use. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6253897/ http://dx.doi.org/10.1093/ofid/ofy210.1465 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Li, Lisa
Calissi, Piera
Blondel-Hill, Edith
Wang, Bing
Wilmer, Amanda
1809. Improved Vancomycin Utilization With Rapidly Available Xpert MRSA/SA BC PCR and Microbiologist Case Review
title 1809. Improved Vancomycin Utilization With Rapidly Available Xpert MRSA/SA BC PCR and Microbiologist Case Review
title_full 1809. Improved Vancomycin Utilization With Rapidly Available Xpert MRSA/SA BC PCR and Microbiologist Case Review
title_fullStr 1809. Improved Vancomycin Utilization With Rapidly Available Xpert MRSA/SA BC PCR and Microbiologist Case Review
title_full_unstemmed 1809. Improved Vancomycin Utilization With Rapidly Available Xpert MRSA/SA BC PCR and Microbiologist Case Review
title_short 1809. Improved Vancomycin Utilization With Rapidly Available Xpert MRSA/SA BC PCR and Microbiologist Case Review
title_sort 1809. improved vancomycin utilization with rapidly available xpert mrsa/sa bc pcr and microbiologist case review
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253897/
http://dx.doi.org/10.1093/ofid/ofy210.1465
work_keys_str_mv AT lilisa 1809improvedvancomycinutilizationwithrapidlyavailablexpertmrsasabcpcrandmicrobiologistcasereview
AT calissipiera 1809improvedvancomycinutilizationwithrapidlyavailablexpertmrsasabcpcrandmicrobiologistcasereview
AT blondelhilledith 1809improvedvancomycinutilizationwithrapidlyavailablexpertmrsasabcpcrandmicrobiologistcasereview
AT wangbing 1809improvedvancomycinutilizationwithrapidlyavailablexpertmrsasabcpcrandmicrobiologistcasereview
AT wilmeramanda 1809improvedvancomycinutilizationwithrapidlyavailablexpertmrsasabcpcrandmicrobiologistcasereview