Evaluation of a pharmacy-driven methicillin-resistant Staphylococcus aureus surveillance protocol in pneumonia.

Background Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of pneumonia and clinicians must determine when empiric antimicrobial therapy directed toward MRSA is needed. Objective To evaluate the effect of a pharmacy-driven protocol utilizing the nasal swab MRSA polymerase chain reaction (PCR) test to discontinue vancomycin on duration of vancomycin therapy and clinical outcomes in patients with suspected community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP). Setting A teaching hospital in Huntington, WV, USA. Methods This retrospective study included adult patients who received at least one dose of vancomycin for suspected CAP or HCAP. The pre-intervention group consisted of patients prior to the addition of the nasal swab MRSA PCR test to the CAP/HCAP order set. The post-intervention group consisted of patients after the addition of the nasal swab MRSA PCR test to the CAP/HCAP order set. Main outcome measure The primary outcome was vancomycin hours of therapy. Results Of the 196 patients included in the study, 121 patients were in the pre-intervention group and 75 patients were in the post-intervention group. The median duration of vancomycin therapy was significantly shorter in the post-intervention group than the pre-intervention group (49 vs. 18 h, p < 0.001). There were no statistically significant differences in the secondary outcomes including hospital length of stay, 30-day readmission rate, and in-hospital all-cause mortality. Conclusion The addition of a pharmacy-driven protocol utilizing the nasal swab MRSA PCR test was associated with shorter duration of empiric vancomycin therapy by approximately 31 h per patient without increasing adverse clinical outcomes.

Predictors of student performance on the Pharmacy Curriculum Outcomes Assessment at a new school of pharmacy using admissions and demographic data.

OBJECTIVES: To characterize student performance on the Pharmacy Curriculum Outcomes Assessment (PCOA) and to determine the significance of specific admissions criteria and pharmacy school performance to predict student performance on the PCOA during the first through third professional years. METHODS: Multivariate linear regression models were developed to study the relationships between various independent variables and students' PCOA total scores during the first through third professional years. RESULTS: To date, four cohorts have successfully taken the PCOA examination. Results indicate that the Pharmacy College Admissions Test (PCAT), the Health Science Reasoning Test (HSRT), and cumulative pharmacy grade point average were the only consistent significant predictors of higher PCOA total scores across all students who have taken the exam at our school of pharmacy. CONCLUSION: The school should examine and clarify the role of PCOA within its curricular assessment program. Results suggest that certain admissions criteria and performance in pharmacy school are associated with higher PCOA scores.

Clinical utility of a nasal swab methicillin-resistant Staphylococcus aureus polymerase chain reaction test in intensive and intermediate care unit patients with pneumonia.

This retrospective study aimed to validate the concordance between nasal swab methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) test and respiratory culture and to determine the number of potentially preventable days of anti-MRSA therapy in patients with pneumonia. Two hundred adult inpatients in the intensive and intermediate care units were included. The nasal swab MRSA PCR test was positive in 55 (27.5%) patients. MRSA was isolated from respiratory culture in 21 (10.5%) patients. The nasal swab MRSA PCR test demonstrated 90.5% sensitivity, 79.9% specificity, 34.5% positive predictive value, and 98.6% negative predictive value. Anti-MRSA therapy was initiated in 168 (84%) patients. Patients in the study received a combined 782days of anti-MRSA therapy; 300days were considered potentially preventable. This study suggests that the nasal swab MRSA PCR test may be used to guide discontinuation of anti-MRSA antibiotics in patients with clinically confirmed pneumonia in the intensive or intermediate care units.