Impact of stewardship pharmacist driven MRSA nasal surveillance and de-escalation of anti-MRSA therapy (STEW PHARM MRSA NASAL SURVEILLANCE).

Objective: To determine if implementing stewardship pharmacist-driven methicillin-resistant (MRSA) nasal surveillance increases use of the test and reduces the inappropriate use of vancomycin for MRSA coverage in patients with pneumonia.

Design: Retrospective pre-/post-intervention study.

Setting: Large teaching acute care hospital.

Participants: Adult patients receiving vancomycin therapy for treatment of pneumonia.

Methods: A stewardship pharmacist ran a report of admitted patients receiving vancomycin and reviewed the patients' records. If the patient's indication was pneumonia and a MRSA nasal swab had not been ordered, the pharmacist contacted the patient's provider and requested an order for it. Upon receipt of a negative MRSA nasal swab result, the pharmacist recommended discontinuation of vancomycin if appropriate.The control group was four weeks prior to the stewardship intervention, where there was no dedicated stewardship pharmacist reviewing MRSA swab utilization. The primary outcome was percentage of patients who had a MRSA swab ordered. Secondary outcomes included percentage of patients who had vancomycin appropriately de-escalated based on MRSA nasal swab results and length of vancomycin therapy.

Result: Percentage of swabs ordered increased from 36.1% (22/61) to 83.7% (41/49) with pharmacist intervention ( < 0.0001). The rate of vancomycin de-escalation following a negative MRSA swab increased from 19.7% (12/61) to 61.2% (30/49) with pharmacist intervention ( < 0.0001).

Conclusion: The results suggest implementing a pharmacist driven MRSA nasal surveillance program into practice could increase the number of MRSA nasal swabs ordered and promote timely de-escalation of vancomycin in patients with pneumonia.