{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:14:33Z","timestamp":1792613673269,"version":"4.5.0"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":334,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S2732494X25102349_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Methicillin-resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (MRSA) is a pathogen commonly implicated in pneumonia for which vancomycin is often used to cover empirically. Our study examined the impact of a pharmacy-based automatic MRSA polymerase chain reaction (PCR) nares intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102349_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included patients prescribed vancomycin for pneumonia and defined three cohorts: pre-intervention (Cohort 1), post-test implementation (Cohort 2), and post-test implementation with electronic medical record (EMR) enhancements and active stewardship involvement (Cohort 3). The primary outcome was total duration of vancomycin treatment. We performed a desirability of outcome ranking with response adjusted for duration of antibiotic risk (DOOR\/RADAR) analysis to prioritize clinical outcomes including adverse events, escalation of care, and death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102349_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The median duration of vancomycin therapy decreased between Cohorts 1 and 2 (55 versus 47 hours,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.15), with a greater decrease detected among the subset of Cohort 2 patients from whom the PCR test was actually collected (42 hours,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.035). Duration of therapy was lowest in Cohort 3 (22.3 hours,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). In the DOOR\/RADAR analysis, no meaningful difference in clinical outcomes was detected between Cohorts 1 and 2 (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.55). Cohort 3 had substantially better ranked outcomes when compared to Cohorts 1 and 2 (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102349_as4\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Vancomycin treatment duration was shorter in patients after a pharmacy-directed, EMR-based MRSA PCR intervention was implemented, with a greater response after implementation of additional EMR enhancements and active stewardship involvement, improving test collection rate and result response. This study will help inform future interventions pairing automated EMR-based interventions with stewardship team efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ash.2025.10234","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T08:01:02Z","timestamp":1764576062000},"source":"Crossref","is-referenced-by-count":2,"title":["Implementation of an automated methicillin-resistant\n                    <i>Staphylococcus aureus<\/i>\n                    polymerase chain reaction screening intervention to guide discontinuation of vancomycin for pneumonia"],"prefix":"10.1017","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9673-6236","authenticated-orcid":false,"given":"Reem","family":"Azem","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01gc0wp38","id-type":"ROR","asserted-by":"publisher"}],"name":"University Hospitals of Cleveland (Cleveland Medical Center)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elie A.","family":"Saade","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01gc0wp38","id-type":"ROR","asserted-by":"publisher"}],"name":"University Hospitals of Cleveland (Cleveland Medical Center)"},{"name":"Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8078-169X","authenticated-orcid":false,"given":"Courtney","family":"Veltri","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01gc0wp38","id-type":"ROR","asserted-by":"publisher"}],"name":"University Hospitals of Cleveland (Cleveland Medical Center)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6665-2680","authenticated-orcid":false,"given":"Nicholas J.","family":"Newman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01gc0wp38","id-type":"ROR","asserted-by":"publisher"}],"name":"University Hospitals of Cleveland (Cleveland Medical Center)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5921-4838","authenticated-orcid":false,"given":"Natalie","family":"Kolehmainen","sequence":"additional","affiliation":[{"name":"University Hospitals of Cleveland (Ahuja Medical Center)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2275-3102","authenticated-orcid":false,"given":"Khoi","family":"Dang","sequence":"additional","affiliation":[{"name":"University Hospitals of Cleveland (Ahuja Medical Center)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8314-7638","authenticated-orcid":false,"given":"Lisa M.","family":"Stempak","sequence":"additional","affiliation":[{"name":"Case Western Reserve University"},{"name":"Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2966-2940","authenticated-orcid":false,"given":"Brigid M.","family":"Wilson","sequence":"additional","affiliation":[{"name":"VA Northeast Ohio Healthcare System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4364-8141","authenticated-orcid":false,"given":"Leila S.","family":"Hojat","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01gc0wp38","id-type":"ROR","asserted-by":"publisher"}],"name":"University Hospitals of Cleveland (Cleveland Medical Center)"},{"name":"Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"S2732494X25102349_ref9","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01805-13"},{"key":"S2732494X25102349_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2022.03.009"},{"key":"S2732494X25102349_ref15","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ495"},{"key":"S2732494X25102349_ref20","doi-asserted-by":"publisher","DOI":"10.1177\/08971900221130893"},{"key":"S2732494X25102349_ref13","first-page":"e217","article-title":"Methicillin-resistant Staphylococcus aureus nasal screening with polymerase chain reaction for early de-escalation of empiric vancomycin in the treatment of suspected\/confirmed respiratory infection in critically ill patients","volume":"32","author":"Lin","year":"2025","journal-title":"Am J Ther"},{"key":"S2732494X25102349_ref7","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-017-0764-7"},{"key":"S2732494X25102349_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2012.02.001"},{"key":"S2732494X25102349_ref10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-336"},{"key":"S2732494X25102349_ref2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200405-644ST"},{"key":"S2732494X25102349_ref5","unstructured":"5. 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Centers for Disease Control and Prevention. About vancomycin-resistant staphylococcus aureus. Centers for disease control and prevention. 2024. https:\/\/www.cdc.gov\/staphylococcus-aureus\/about\/vancomycin-resistant-staph.html. 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