ArticleAntimicrobial agents and chemotherapy2013
A trial of discontinuation of empiric vancomycin therapy in patients with suspected methicillin-resistant Staphylococcus aureus health care-associated pneumonia.
Article in Antimicrobial agents and chemotherapy, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- [Consensus guidelines for the management of community acquired pneumonia in the elderly patient].Revista espanola de geriatria y gerontologiaGuideline
- Discontinuation Patterns and Cost Avoidance of a Pharmacist-Driven Methicillin-ResistantOpen forum infectious diseases · 2021Article
- Multifunctional Biochar for Highly Efficient Capture, Identification, and Removal of Toxic Metals and Superbugs from Water Samples.ACS omega · 2017Article
- A retrospective study of antibiotic de-escalation in patients with ventilator-associated pneumonia in Malaysia.International journal of clinical pharmacy · 2017Observational
- Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program.BMC infectious diseases · 2016Article
- Using MRSA Screening Tests To Predict Methicillin Resistance in Staphylococcus aureus Bacteremia.Antimicrobial agents and chemotherapy · 2016Article
- Derivation and Multicenter Validation of the Drug Resistance in Pneumonia Clinical Prediction Score.Antimicrobial agents and chemotherapy · 2016Article
- Antimicrobial de-escalation of treatment for healthcare-associated pneumonia within the Veterans Healthcare Administration.The Journal of antimicrobial chemotherapy · 2016Article
- Rapid automated microscopy for microbiological surveillance of ventilator-associated pneumonia.American journal of respiratory and critical care medicine · 2015Article
- Inappropriate continued empirical vancomycin use in a hospital with a high prevalence of methicillin-resistant Staphylococcus aureus.Antimicrobial agents and chemotherapy · 2015Article
- Does universal active MRSA surveillance influence anti-MRSA antibiotic use? A retrospective analysis of the treatment of patients admitted with suspicion of infection at Veterans Affairs Medical Centers between 2005 and 2010.The Journal of antimicrobial chemotherapy · 2014Article
- Article
- Predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab PCR assay for MRSA pneumonia.Antimicrobial agents and chemotherapy · 2014Article
- Antimicrobial Stewardship Programs: Appropriate Measures and Metrics to Study their Impact.Current treatment options in infectious diseasesReview
- Nasal-Swab Results for Methicillin-ResistantThe Canadian journal of hospital pharmacyArticle
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Healthcare-associated pneumonia (HCAP) guidelines recommend de-escalating initial antibiotic therapy based on results from lower-respiratory-tract cultures. In the absence of adequate lower respiratory cultures, physicians are sometimes reluctant to discontinue empirical vancomycin, which is given for suspected methicillin-resistant Staphylococcus aureus (MRSA) HCAP. We evaluated a strategy of discontinuing vancomycin if both nasal and throat cultures were negative for MRSA when lower-respiratory-tract cultures were not available. An antimicrobial stewardship team identified patients receiving empirical vancomycin for suspected or proven HCAP but for whom adequate lower-respiratory-tract cultures were not available. Nasal and throat swab specimens were obtained and plated on MRSA selective media. If both nasal and throat MRSA cultures were negative, the stewardship team recommended discontinuation of empirical vancomycin. Demographic and clinical aspects, a clinical pulmonary infection score (CPIS) on the day of the stewardship recommendation, and mortality of patients for whom vancomycin was discontinued were obtained by retrospective chart review. A convenience sample of 91 patients with nasal and throat cultures negative for MRSA in the absence of adequate respiratory cultures had empirical vancomycin therapy discontinued. A retrospective review revealed that 88 (97%) patients had a CPIS of ≤6 on the day of the stewardship recommendation. In-hospital mortality (7.7%) was similar to that of a previous study of de-escalation of antibiotics in pneumonia patients without adequate cultures. In the absence of adequate lower-respiratory-tract cultures, it is reasonable to discontinue empirical vancomycin HCAP therapy in patients with negative MRSA nasal and throat cultures and a CPIS of <6.
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