ACS 2019: A Pilot Study of De-Implementation of Empiric Vancomycin Use in Surgical Inpatients

San Francisco, California ( Leah Chisholm, Vanderbilt University School of Medicine, Nashville, TN discussed how surgical inpatients suspected of infection are frequently treated empirically with the antibiotic vancomycin to cover for potential Methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecium (E. faecium) infection. Non-soft tissue MRSA and EF infections are relatively rare in surgical populations and vancomycin has significant costs and potential morbidities.   Thus, empiric vancomycin use in non-critically ill inpatients may represent low-value care. She reported results from a pilot study that evaluated an audit and feedback-based vancomycin de-implementation program in a single surgical department (Urology).

An empiric vancomycin de-implementation protocol was developed in collaboration with the Antimicrobial Stewardship Program. All Urology clinical providers were exposed to educational interventions about vancomycin overuse and the de-implementation protocol in Oct 2018. Vancomycin use was then prospectively tracked and audited for protocol compliance. Feedback to providers and qualitative assessments with trainees were performed monthly. Statistical Process Control charts were used for progress analysis.

Since the initiation of the de-implementation protocol in Nov 2018, only 2/63 (3.2%) clinically stable urology inpatients suspected of infection received empiric vancomycin. This represents a 74% decrease in empiric vancomycin use from the prior year. There were no adverse events related to reduced empiric vancomycin use. Mean days of therapy (DOT) per 1000 days decreased from 315 to 19 (89%) in the post-intervention period (p<0.01).

In conclusion, de-implementation of empiric vancomycin use in non-critically ill surgical inpatients was achieved in this pilot study on the Urology service. Educational and audit/feedback methods may be successful in future vancomycin de-implementation efforts in surgical populations. Similar, antimicrobial stewardships are active at my institution and worldwide with education rather than hard stops appearing to be most effective means to provide high-quality care as illustrated in this pilot study.

Presented by: Leah Chisholm, Vanderbilt University School of Medicine, Nashville, Tennessee