Acuna-Villaorduna, CarlosBranch-Elliman, WestynStrymish, JudithGupta, Kalpana2022-04-202017-10Acuna-Villaorduna, Carlos, Westyn Branch-Elliman, Judith Strymish, Kalpana Gupta. "Active Identification of Patients Who Are Methicillin-Resistant Staphylococcus Aureus Colonized Is Not Associated With Longer Duration of Vancomycin Therapy." American Journal of Infection Control 45, no. 10 (2017): 1081-1085. DOI: 10.1016/j.ajic.2017.04.0110196-6553https://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37371383Background Excessive prescribing of vancomycin among patients admitted to inpatient wards is a challenge for antimicrobial stewardship programs, especially in the setting of expanded screening programs for methicillin-resistant Staphylococcus aureus (MRSA). Studies examining factors associated with longer duration of vancomycin use are limited. Methods We conducted a retrospective cohort study to assess the impact of universal MRSA admission screening on duration of vancomycin use at the VA Boston Healthcare System during the period from January 2013-November 2015. Results A total of 2,910 patients were administered intravenous vancomycin during the study period. A clinical culture positive for MRSA was strongly associated with vancomycin administration lasting >72 hours (odds ratio [OR], 2.72; 95% confidence interval [CI], 1.86-3.97; P < .001). After controlling for clinical culture results, admission MRSA colonization was not associated with vancomycin use past 72 hours (OR, 0.94; 95% CI, 0.8-1.1). A negative MRSA nasal swab on admission had a high negative predictive value for all MRSA infections evaluated (99.6% for pneumonia, 99.6% for bloodstream infection, and 98.1% for skin and soft tissue infection). Conclusions Admission surveillance for MRSA nasal colonization is not a major driver of prolonged vancomycin use. A negative admission MRSA nasal screen may be a useful tool for antimicrobial stewardship programs to limit vancomycin use, particularly in noncritically ill patients.en-USInfectious DiseasesPublic Health, Environmental and Occupational HealthHealth PolicyEpidemiologyJournal Article2017-09-1120172022-04-2010.1016/j.ajic.2017.04.011