Impact of a pharmacist-driven methicillin-resistant Staphylococcus aureus surveillance protocol

Purpose. Results of a study to evaluate the impact of a pharmacist-driven methicillin-resistant Staphylococcus aureus (MRSA) surveillance screening protocol are reported. Methods. A retrospective single-center, quasi-experimental, pre-post cohort study was conducted to assess medication-use and clinical outcomes before and after implementation of a protocol allowing pharmacists to order nasal swabs and polymerase chain reaction (PCR) testing for MRSA in selected patients receiving vancomycin for pneumonia or acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Negative assay results were used to guide de-escalation of vancomycin therapy. The primary outcome was vancomycin days of therapy (DOT). Secondary outcomes included hospital length of stay, the rate of vancomycin-associated acute kidney injury, and in-hospital mortality. Results. A total of 300 patients were identified for inclusion in the pre-protocol group (n = 150) or postprotocol group (n = 150) through medical records review. Compared with patients in the preprotocol group, those in the postprotocol group had a median 2.1-day reduction in vancomycin DOT (2.1 days versus 4.2 days, p < 0.0001). Protocol implementation was also associated with a decrease in the median number of vancomycin serum levels obtained per patient but did not have a significant impact on other secondary outcomes. Conclusion. Among patients with suspected or confirmed pneumonia or an AECOPD, the expansion of pharmacists' traditional scope of practice to include a surveillance protocol using a MRSA PCR nares assay to guide vancomycin de-escalation resulted in a reduction in vancomycin utilization without compromising clinical outcomes.