Clinician Education to Promote Methicillin-resistant Staphylococcus Aureus (MRSA) Nucleic Acid Amplification Test (NAAT)-Guided De-escalation
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Publication Date
2025
Abstract
Anti-MRSA agents are commonplace in many empiric antimicrobial regimens. However, prolonged use of these drugs is associated with significant drug toxicities and development of resistant organisms such as Vancomycin-resistant Enterococci. In recent retrospective studies, the MRSA NAAT, traditionally used in pulmonary infections, has also demonstrated a strong concordance with cultures and high negative predictive value (NPVs) in a variety of other infection sites. However, in practice, clinicians often restrict the use of MRSA NAAT to pulmonary infections. Though it often takes years for research evidence to be integrated into clinical practice, lack of awareness about the broad utility of the MRSA NAAT may also contribute to its underuse. Providing comprehensive education to clinicians could translate into changes in prescribing habits and subsequently, changes in acute kidney injury (AKI) rates, length of stay (LOS), time to de-escalation and in-hospital mortality. The goal of this study will be to determine the impact of clinician education on utilization of negative MRSA NAAT results for non-pulmonary infections. This is a quasi-experimental pre/post-intervention study approved by the Institutional Review Board. The electronic medical record system was used to identify patients aged 18 years and older admitted to a Providence Oregon hospital between May 01, 2021 through November 30, 2023. Patients were included if they had a negative MRSA NAAT and received IV vancomycin treatment. Patients admitted from May 01, 2021 through May 2, 2023 will be considered pre-intervention. Patient admitted May 3, 2023 through August 22, 2023 will be considered post-intervention 1, and patients admitted August 22, 2023 through November 30,2023 will be considered post-intervention 2. Patients with inconclusive/positive MRSA NAATs were excluded. The primary outcome of this study is to evaluate the frequency of vancomycin de-escalation within 24 hours of a negative MRSA NAAT before and after providing education to clinicians on the utility of the MRSA NAAT. Secondary outcomes include evaluating the length of stay (LOS), Vancomycin acute kidney injury (AKI), IV vancomycin days of therapy (DOT standardized per 1,000 patient-days), time to de-escalation, and in-hospital mortality for patients based on the presence MRSA NAAT-guided de-escalation. Two-way ANOVA tests will be performed to assess differences between pre and post frequencies of early vancomycin de-escalation. Learning objectives: Evaluate the effect of clinical education on the frequency of early MRSA NAAT-guided de-escalation of vancomycin. Presentation category: Infectious disease
Specialty/Research Institute
Graduate Medical Education
