Swab Testing to Optimize Pneumonia treatment with empiric Vancomycin (STOP-Vanc): study protocol for a randomized...

Area of Science:

• Infectious Diseases
• Clinical Trials
• Antimicrobial Stewardship

Background:

• Vancomycin is often empirically used for community-acquired pneumonia (CAP), despite rare MRSA involvement.
• Methicillin-resistant Staphylococcus aureus (MRSA) colonization testing via nasal swabs is a proposed antimicrobial stewardship intervention.
• Previous observational studies suggest reduced vancomycin use with MRSA testing, but randomized controlled trial (RCT) data are lacking.

Purpose of the Study:

• To evaluate the efficacy of MRSA nasal swab PCR testing in guiding vancomycin de-escalation for suspected CAP.
• To provide the first RCT data on using MRSA PCR testing for antibiotic stewardship.
• To assess the impact of MRSA PCR testing and stewardship guidance on clinical outcomes in an ICU setting.

Main Methods:

• The STOP-Vanc trial is a pragmatic, prospective, single-center, non-blinded RCT in adult patients with suspected CAP receiving vancomycin in the ICU.
• Patients are randomized 1:1 to receive MRSA nasal swab PCR testing plus usual care or usual care alone.
• The primary outcome is vancomycin-free hours alive within seven days of enrollment.

Main Results:

• This section is to be filled once the study results are available.

Conclusions:

• This trial will offer crucial RCT evidence on MRSA nasal swab PCR testing's role in antibiotic de-escalation.
• Findings will inform antimicrobial stewardship practices and vancomycin utilization in CAP management within intensive care settings.