Optimization of vancomycin use in hospitalized patients with pneumonia through implementation of informatics based antimicrobial stewardship program (ASP) intervention.

OBJECTIVE

Vancomycin overuse in pneumonia should be a key target for antimicrobial stewardship according to Centers for Disease Control and Prevention. High negative predictive value of nasal Methicillin Resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) (nMP) screening for pneumonia has been shown. We implemented informatics-based ASP intervention to reduce vancomycin use in pneumonia by 20% in 6 months.

DESIGN

Quasi-experimental: Pre-intervention period (P1: 4/1/24-9/30/24) compared with post-intervention period (P2: 10/15/24-3/15/2025).

SETTING

Quality improvement (QI) initiative in a tertiary-care center in Upper Midwest.

PATIENTS: Hospitalized pneumonia patients.

INTERVENTIONS: Automated default nMP order was incorporated in pneumonia order-set in electronic medical record while ordering vancomycin for hospital acquired/ventilator associated pneumonia, severe community acquired pneumonia.

RESULTS

Outcome measures declined significantly: Average vancomycin use density as reported with days of therapy (DOT)/1,000 patient days decreased by 49.5% (from 72.2 DOT/1,000 patient days in P1 to 36.3 DOT/1,000 patient days in P2; p < .0001). Average vancomycin drug inventory cost decreased by 50% (from 1,089.5 U.S. Dollars (USD)/1,000 patient days in P1 to 546.3 USD/1,000 patient days in P2; p < .0001). All process measures showed significant changes: nMP ordering increased to 100% in P2 (p < .0001); proportion of pneumonia patients with negative PCR results with discontinuation of vancomycin within 48-72 hours increased to 71% (p < .0001) and time to vancomycin discontinuation declined by 46% (p < .001). Balancing measures (readmissions; nMP order-to-result time) remained unchanged.

CONCLUSIONS

Informatics-based ASP intervention was transformative leading to significant decline in vancomycin utilization, considerable healthcare-cost savings and significant increase in nMP screening among pneumonia patients.