Vancomycin De-escalation Therapy in Patients With Pneumonia
| Status: | Recruiting |
|---|---|
| Conditions: | Pneumonia |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 7/15/2018 |
| Start Date: | February 8, 2018 |
| End Date: | December 30, 2019 |
| Contact: | Audis Bethea, PharmD, BCPS |
| Email: | audis.bethea@camc.org |
| Phone: | 304-388-3653 |
Vancomycin De-escalation Therapy in Patients With Pneumonia and Negative MRSA Nasal Swab
This is a non-inferiority study evaluating clinical improvement rate when using MRSA nasal
swabs to guide discontinuation of vancomycin for empiric coverage for MRSA pneumonia.
swabs to guide discontinuation of vancomycin for empiric coverage for MRSA pneumonia.
Current clinical guidelines recommend including vancomycin in initial empiric therapy if risk
factors for MRSA infection are present, or there is a high incidence of MRSA locally.
Prolonged exposure to vancomycin, however, has been linked with the risk of
vancomycin-associated kidney failure. Studies have reported that a MRSA nasal swab may be
used to predict the presence of MRSA pneumonia. Specifically, pneumonia patients with
negative MRSA nasal swabs are 95-99% likely to not have pneumonia due to MRSA. There is
limited data, however, evaluating the use of a MRSA nasal swab to guide vancomycin therapy.
Accordingly, in this study, pneumonia patients in the intervention arm will have empiric
vancomycin discontinued following a negative MRSA nasal swab. In the control arm, patients
vancomycin will not be discontinued based on the MRSA nasal swab result. The rate of clinical
resolution will be compared between these two study arms.
factors for MRSA infection are present, or there is a high incidence of MRSA locally.
Prolonged exposure to vancomycin, however, has been linked with the risk of
vancomycin-associated kidney failure. Studies have reported that a MRSA nasal swab may be
used to predict the presence of MRSA pneumonia. Specifically, pneumonia patients with
negative MRSA nasal swabs are 95-99% likely to not have pneumonia due to MRSA. There is
limited data, however, evaluating the use of a MRSA nasal swab to guide vancomycin therapy.
Accordingly, in this study, pneumonia patients in the intervention arm will have empiric
vancomycin discontinued following a negative MRSA nasal swab. In the control arm, patients
vancomycin will not be discontinued based on the MRSA nasal swab result. The rate of clinical
resolution will be compared between these two study arms.
Inclusion Criteria:
- Age >= 18 years old
- Patients admitted to Charleston Area Medical Center (CAMC) through the Emergency
Department who meet the CDC criteria for pneumonia.
- Nasal surveillance culture for MRSA obtained in the Emergency Department
- Patients receiving vancomycin and additional antibiotic therapy for gram-negative
coverage
Exclusion Criteria:
- Persistent vasopressor requirements when MRSA nasal swab results are available
- Patients not meeting the CDC criteria for pneumonia
- Patients presenting to the ED with leukopenia (≤4000) without previous documentation
of normal or elevated WBC
- Patients receiving empiric MRSA antibiotic therapy other than vancomycin for pneumonia
- Patients with the diagnosis of lung abscess
- Patients not receiving vancomycin therapy before MRSA nasal swab results are reported
- Immunocompromised individuals. i.e. patients with AIDS/HIV, vasculitis on immune
suppressor therapy, steroid therapy for more than one week prior admission or who
received chemotherapy in the last 3 months
- Patients who do not have a MRSA nasal swab obtained in the ED
- Nares swab obtained after the completion of the first administered dose of an
antibiotic with activity against MRSA
- Patients with MRSA bacteremia
- Patients with chronic tracheostomy
We found this trial at
1
site
Charleston, West Virginia 25304
Principal Investigator: Hesham Mohamed, MD
Phone: 304-388-3653
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