{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T10:08:00Z","timestamp":1767953280917,"version":"3.49.0"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Am Coll Clin Pharm"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Vancomycin is commonly used in pediatric intensive care units (PICUs) to treat methicillin\u2010resistant\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      <\/jats:styled-content>\n                      (MRSA) infections. While previous interventions in children's hospitals have successfully targeted vancomycin use, few have incorporated MRSA nasal polymerase chain reaction (PCR) testing. The MRSA PCR has been shown to reliably rule out MRSA infection and reduce vancomycin therapy duration in adults, but data in children are limited. This study aimed to evaluate the impact of an antimicrobial stewardship intervention on vancomycin use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included patients less than 18\u2009years old who received vancomycin in the PICU between January 1, 2019 and June 30, 2024. The primary outcome was vancomycin days of therapy (DOT) before and after the antimicrobial stewardship intervention. Secondary outcomes included acute kidney injury (AKI), hospital length of stay, and MRSA PCR sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 251 patients were included, with 126 in the pre\u2010group and 125 in the post\u2010group. The median age was 2\u2009years, and 60% were mechanically ventilated. The most common indication for vancomycin was sepsis of unknown origin (47%). The median vancomycin DOT was 4\u2009days in both groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033). In patients without confirmed MRSA infection, the median duration was shorter in the post\u2010group (4 vs. 3\u2009days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009). More patients in the post\u2010group had vancomycin discontinued at 72\u2009h (38.9% vs. 61.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). No significant differences were observed in secondary outcomes. The MRSA PCR sensitivity, specificity, PPV, and NPV were 66.7%, 92.7%, 34.5%, and 98.3%, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This intervention in PICU patients at an academic medical center led to more rapid vancomycin discontinuation and shorter DOT. The MRSA PCR demonstrated a high NPV, supporting its use as an antimicrobial stewardship tool.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jac5.70169","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T11:50:53Z","timestamp":1767873053000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Targeted Antimicrobial Stewardship in a Pediatric Intensive Care Unit: Using the Methicillin\u2010Resistant\n                    <i>Staphylococcus aureus<\/i>\n                    (\n                    <scp>MRSA<\/scp>\n                    ) Nasal Polymerase Chain Reaction (\n                    <scp>PCR<\/scp>\n                    ) to Reduce Vancomycin Days of Therapy"],"prefix":"10.1002","volume":"9","author":[{"given":"Bailey","family":"Bridges","sequence":"first","affiliation":[{"name":"Department of Pharmacy University of Mississippi Medical Center  Jackson Mississippi USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Mississippi Medical Center  Jackson Mississippi USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Whitney","family":"Mays","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Mississippi Medical Center  Jackson Mississippi USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2037-2616","authenticated-orcid":false,"given":"Mary Joyce B.","family":"Wingler","sequence":"additional","affiliation":[{"name":"Department of Antimicrobial Stewardship University of Mississippi Medical Center  Jackson Mississippi USA"},{"name":"Division of Infectious Diseases, Department of Medicine University of Mississippi Medical Center  Jackson Mississippi USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e31828a846d"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.inf.0000178064.55193.1c"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020\u2010009142"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021\u2010052165"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181d683f8"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq146"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01590\u201009"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxab296"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piae023"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piad111"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02432\u201016"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_11_14_1","first-page":"1","article-title":"KDIGO Clinical Practice Guideline for Acute Kidney Injury","volume":"2","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group","year":"2012","journal-title":"Kidney International. Supplement"},{"key":"e_1_2_11_15_1","unstructured":"Centers for Disease Control and Prevention \u201cAntimicrobial Use and Resistance Module Protocol. National Healthcare Safety Network Patient Safety Component Manual \u201daccessed July 17 2025 https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/11pscaurcurrent.pdf."},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000002084"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piy016"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000004533"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz974"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2188"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2022.256"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2023.190"}],"container-title":["JACCP:  JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jac5.70169","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T08:28:17Z","timestamp":1767947297000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/jac5.70169"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1002\/jac5.70169"],"URL":"https:\/\/doi.org\/10.1002\/jac5.70169","archive":["Portico"],"relation":{},"ISSN":["2574-9870","2574-9870"],"issn-type":[{"value":"2574-9870","type":"print"},{"value":"2574-9870","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-07-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70169"}}