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Background Methicillin-resistant Staphylococcus aureus (MRSA), when implicated in respiratory tract infections, can be associated with significant morbidity and mortality. The prevalence of severe MRSA pneumonia may be as high as 10%; however, recent evidence suggests that MRSA is much less prevalent as a cause of community-acquired pneumonia (CAP) among community-dwelling patients and may be as low as 0.1%. Nonspecific features of pneumonia in non-ICU patients (viral co-infection, multi-lobar infiltrates) often lead clinicians to cautiously initiate empiric anti-MRSA therapy. Recommendations of when to safely de-escalate empiric treatment prior to known respiratory cultures are not established. To decrease anti-MRSA therapy in non-ICU pneumonia patients with a low probability of MRSA pneumonia, we employed a nasal screening paired with antimicrobial stewardship intervention. Methods A retrospective, single-center, pre-post interventional study was conducted at Northwestern Memorial Hospital (NMH), in Chicago, IL, to assess the duration of empiric vancomycin for suspected MRSA pneumonia in non-ICU patients before (January 2019) and after (March 2019) the implementation of a rapid MRSA nasal PCR test. During the post-implementation period, an NMH Antimicrobial Stewardship (AS) member identified and assessed the daily (M-F) use of empiric vancomycin for pneumonia in non-ICU patients. When vancomycin use criteria were not met, the AS pharmacist requested the team order a BD MRSA Nasal PCR test (NPV: 97.2%) to classify patients as either possible MRSA pneumonia or unlikely MRSA pneumonia. Results of a negative MRSA Nasal PCR with an ongoing clinical disposition not suggestive of MRSA pneumonia prompted the AS pharmacist to recommend de-escalation of vancomycin. Results See table. Conclusion The use of a rapid MRSA nasal PCR test with active antimicrobial stewardship intervention significantly reduced the duration of empiric vancomycin in hospitalized non-ICU patients with suspected MRSA pneumonia. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Purpose. A methodology for predicting how long the on-hand inventory of a given medication will last during a supply shortage is described; a practical example of application of the methodology is provided. Methods. Single-site data on consumption of i.v. tobramycin over an eight-month evaluation period were collected using commercial software that tabulates barcode-assisted medication administration (BCMA) events; administered doses were standardized as 1200-mg "vial-equivalents" and summed over the review period. The total number of vial-equivalents consumed was divided by the number of "non-zero weeks of consumption" (i.e., weeks during which any tobramycin use occurred) to obtain a mean ± S.D. weekly consumption rate; this rate was multiplied by the total i.v. tobramycin on-hand supply (in vial-equivalents) to determine the mean number of potentially sustainable weeks of therapy in the event a shortage were to restrict the future supply of the drug. Results. Overall, 99.6 vial-equivalents of i.v. tobramycin were used during the evaluation period. The mean ± S.D. number of vial-equivalents used per non-zero week of consumption was 3.11 ± 1.26. A manual count of pharmacy inventory revealed that 102.9 vial-equivalents were available at the time of analysis. The mean predicted duration of supply was 33 weeks (95% confidence interval, -126 to 192 weeks). Conclusion. Available BCMA data on tobramycin consumption over eight months were used to calculate the mean number of weeks the on-hand supply of the drug could be expected to last during a persistent drug shortage. [ABSTRACT FROM AUTHOR]