I’m a Steward! You’re a Steward! We’re all Stewards!

Reviewed by Jen Cihlar, DO, Vanderbilt University Medical Center

As stewardship effort to reduce excessive vancomycin use, a large academic center implemented a protocol allowing all clinical pharmacists to order MRSA nasal swab on all patients started on vancomycin, and later added to the protocol that ongoing vancomycin use after 72-hours required approval by the assigned clinical pharmacist to their service. They found a statistically significant and continued improvement in standardized antimicrobial administration ratio (SAAR) for antibacterial agents targeting resistant gram-positive infections from baseline pre-protocol of 1.26 to 1.13 (P<0.001) after initiation of the MRSA swab protocol and further reduction to 0.96 (P<0.001) after adding the 72-hour approval process for continuation. The SAAR reduction was felt to be attributed to decreased vancomycin use per days of therapy/1000 patient days via NHSN data as there was not significant change in other gram-positive antibiotic use.  This study highlights how utilizing clinical pharmacists, not just members specific to the stewardship team, can effectively help improve antimicrobial utilization efforts at a large academic center.

Pettit NN, Nguyen CT, Lew AK, Pisano J. Impact of the sequential implementation of a pharmacy-driven methicillin-resistant Staphylococcus aureus (MRSA) nasal-swab ordering policy and vancomycin 72-hour restriction protocol on standardized antibiotic administration ratio (SAAR) data for a. Infection Control & Hospital Epidemiology. Published online 2023:1-5. doi:10.1017/ice.2023.190

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