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首页> 外文期刊>Cureus. >Impact of a Pharmacist-driven Methicillin-resistant Staphylococcus aureus Polymerase Chain Reaction Nasal Swab Protocol on the De-escalation of Empiric Vancomycin in Patients with Pneumonia in a Rural Healthcare Setting
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Impact of a Pharmacist-driven Methicillin-resistant Staphylococcus aureus Polymerase Chain Reaction Nasal Swab Protocol on the De-escalation of Empiric Vancomycin in Patients with Pneumonia in a Rural Healthcare Setting

机译：药剂推动的甲氧基硫脲金黄色葡萄球菌聚合酶链反应鼻拭子方案对农村医疗环境肺炎患者经验万古霉素脱升升级的影响

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Introduction Pneumonia caused by methicillin-resistant?Staphylococcus aureus (MRSA) carries a high rate of morbidity and mortality. Many clinicians empirically treat those at risk of developing?MRSA pneumonia with vancomycin. Several studies have identified a high negative predictive value of the MRSA polymerase chain reaction (PCR) nasal swab test in lower respiratory tract infections, suggesting it can be used to guide the de-escalation of empiric anti-MRSA therapy. Objective To evaluate the impact of a pharmacist-driven MRSA PCR nasal swab protocol on the de-escalation of empiric vancomycin in patients with pneumonia in a rural healthcare setting. Secondarily, to assess the rate of hospital length of stay, the rate of vancomycin-associated acute kidney injury, and in-hospital mortality after pharmacist-driven de-escalation of empiric vancomycin in patients with pneumonia. Methods A retrospective, single-center, pre-post cohort study was conducted in patients after the implementation of a pharmacist-driven protocol allowing pharmacists to obtain nasal swabs and PCR?testing for MRSA in those on empiric vancomycin therapy for suspected MRSA pneumonia. Based on negative test results, pharmacists recommended a de-escalation of empiric vancomycin to the physician. Patients were included if they were adults at least 18 years of age, had a physician diagnosis of suspected or confirmed pneumonia, and initiated on at least one dose of intravenous vancomycin within 48 hours of admission. Results A total of 79 patients were identified for inclusion in the pre-protocol group (n=32) or post-protocol group (n= 47). The mean duration of vancomycin therapy in the pre-protocol group was 3.1 days as compared to 1.7 days in the post-protocol group for a 1.4 days reduction (p=0.044). There was no significant impact on the number of vancomycin cases de-escalated within 24 hours (p=0.14) but there was a significant reduction at 48 hours (p=0.01). Protocol implementation was associated with a reduction in the average length of hospitalization (8 versus 5.20 days, p=0.006). Neither group had a vancomycin-associated acute kidney injury or in-hospital mortality. Conclusion Among patients with suspected MRSA pneumonia, a pharmacist-driven MRSA PCR nasal swab protocol resulted in a significant reduction of empiric vancomycin duration of therapy without an adverse impact on clinical outcomes in a rural healthcare setting.
机译：引进肺炎抗甲氧西林的肺炎金黄色葡萄球菌（MRSA）携带高度发病率和死亡率。许多临床医生凭经质对待那些有发展风险的人？MRSA肺炎与万古霉素。几项研究已经确定了MRSA聚合酶链反应（PCR）鼻拭子测试的高阴性预测值，在较低呼吸道感染中，表明它可用于引导经验抗MRSA治疗的脱升升级。目的评价药剂师驱动的MRSA PCR鼻牌牌牌照对农村医疗环境中肺炎患者经验万古霉素脱升升级的影响。其次，评估医院住院时间，万古霉素相关急性肾损伤的率，以及肺炎患者药剂师驱动的肺炎患者的透视升级后的住院死亡率。方法采用回顾性，单中心，在患者实施后，在实施药剂师驱动的方案后，允许药剂师获得鼻拭子和PCR的患者在疑似患有疾病肺炎的经验万古霉素治疗中的MRSA测试。根据负面测试结果，药剂师推荐对医生的经验万霉素脱升升级。包括至少18岁的成年人，患者的患者诊断怀疑或确诊的肺炎，并在入院48小时内至少一剂静脉内万年霉素发起。结果共鉴定了79名患者以包含在预定方案组（N = 32）或协议后组（n = 47）中。在后协议组前的万古霉素治疗的平均持续时间为3.1天，而在后期组的1℃下为1.4天内减少（P = 0.044）。对24小时内脱升的万古霉素病例的数量没有显着影响（P = 0.14），但在48小时内显着降低（P = 0.01）。议定书实施与平均住院时间减少有关（8与5.20天，P = 0.006）。既不是患有过万霉素相关的急性肾损伤或住院医院死亡率。结论涉嫌MRSA肺炎患者，药剂师驱动的MRSA PCR鼻拭子律议定书导致经验性万古霉素治疗持续时间显着降低，对农村医疗环境中的临床结果产生不利影响。

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