{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T02:20:15Z","timestamp":1772504415208,"version":"3.50.1"},"reference-count":14,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X23001903_as1\"><jats:title>Objective:<\/jats:title><jats:p>Vancomycin is often initiated in hospitalized patients; however, it may be unnecessary or continued for longer durations than needed. Oversight of all vancomycin orders may not be feasible with widespread prescribing and strategies to enlist other clinicians to serve as stewards of vancomycin use are needed. We implemented 2 sequential interventions: a protocol in which the pharmacist orders MRSA nasal swab followed by a protocol requiring approval from pharmacists to continue vancomycin for &gt;72 hours.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23001903_as2\"><jats:title>Methods:<\/jats:title><jats:p>In this single-center, retrospective, quasi-experimental study, we evaluated vancomycin use after implementation of a pharmacy-driven MRSA nasal-swab ordering protocol and a vancomycin 72-hour restriction protocol. The primary outcome was the change in the standardized antibiotic administration ratio (SAAR) for antibacterial agents for resistant gram-positive infections. We also evaluated the impact on antibiotic utilization.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23001903_as3\"><jats:title>Results:<\/jats:title><jats:p>Following the MRSA swab protocol, the SAAR decreased from 1.26 to 1.13 (<jats:italic>P<\/jats:italic> &lt; .001; 95% confidence interval [CI], 1.16\u20131.25). After the 72-hour approval process, the SAAR was 0.96 (<jats:italic>P<\/jats:italic> &lt; .001; 95% CI, 1.0\u20131.12). Vancomycin utilization decreased from 138.9 to 125.3 days of therapy per 1,000 patient days following the MRSA swab protocol (<jats:italic>P<\/jats:italic> &lt; .001) and to 112.7 (<jats:italic>P<\/jats:italic> &lt; .001) following the 72-hour approval protocol. Interrupted time-series analysis identified a similar rate of decline in utilization following the 2 interventions (\u22120.3 and \u22120.5; <jats:italic>P<\/jats:italic> = .16). Both interventions combined resulted in a significant reduction (\u22121.5; <jats:italic>P<\/jats:italic> &lt; .001).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23001903_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>Implementation of a pharmacist-driven MRSA nasal-swab ordering protocol, followed by a 72-hour approval protocol, was associated with a significant reduction in the SAAR for antibiotics used in the treatment of resistant gram-positive infections and a reduction in vancomycin utilization. Leveraging the oversight of primary service clinical pharmacists through these protocols proved to be an effective strategy.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2023.190","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T08:53:55Z","timestamp":1694595235000},"page":"196-200","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":7,"title":["Impact of the sequential implementation of a pharmacy-driven methicillin-resistant <i>Staphylococcus aureus<\/i> (MRSA) nasal-swab ordering policy and vancomycin 72-hour restriction protocol on standardized antibiotic administration ratio (SAAR) data for antibiotics used for resistant gram-positive infections"],"prefix":"10.1017","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8937-8039","authenticated-orcid":false,"given":"Natasha N.","family":"Pettit","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8530-6890","authenticated-orcid":false,"given":"Cynthia T.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison K.","family":"Lew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Pisano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"S0899823X23001903_ref4","unstructured":"4. US Department of Health and Human Services. Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/antibiotic-use\/core-elements\/hospital.html. Accessed August 28, 2023."},{"key":"S0899823X23001903_ref3","doi-asserted-by":"publisher","DOI":"10.1177\/0018578719888906"},{"key":"S0899823X23001903_ref5","unstructured":"5. National Healthcare Safety Network. The NHSN standardized antimicrobial administration ratio (SAAR): a guide to the SAAR. Updated November 2020. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/nhsn\/pdfs\/ps-analysis-resources\/aur\/au-saar-guide-508.pdf. Accessed August 28, 2023."},{"key":"S0899823X23001903_ref9","doi-asserted-by":"publisher","DOI":"10.7326\/M13-3016"},{"key":"S0899823X23001903_ref8","doi-asserted-by":"publisher","DOI":"10.1310\/hpj5011-1011"},{"key":"S0899823X23001903_ref10","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2018.249"},{"key":"S0899823X23001903_ref1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.2007"},{"key":"S0899823X23001903_ref11","unstructured":"11. National Healthcare Safety Network (NHSN). AU option case examples. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/nhsn\/au-case-examples\/index.html. Reviewed October 12, 2021. Accessed August 28, 2023."},{"key":"S0899823X23001903_ref12","first-page":"2459","article-title":"Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing","volume":"71","author":"Rawson","year":"2020","journal-title":"Clin Infect Dis"},{"key":"S0899823X23001903_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab236"},{"key":"S0899823X23001903_ref6","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2019.105"},{"key":"S0899823X23001903_ref7","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofx163.605"},{"key":"S0899823X23001903_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab125"},{"key":"S0899823X23001903_ref14","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2021.347"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X23001903","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T08:30:53Z","timestamp":1713861053000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X23001903\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,13]]},"references-count":14,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["S0899823X23001903"],"URL":"https:\/\/doi.org\/10.1017\/ice.2023.190","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,13]]},"assertion":[{"value":"\u00a9 The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}