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 used for community-acquired pneumonia (CAP) despite rare MRSA involvement.
• MRSA nasal swab PCR testing is a proposed stewardship intervention to limit vancomycin use.
• Previous observational studies suggest reduced vancomycin use, but randomized trial data are lacking.

Purpose of the Study:

• To evaluate the efficacy of MRSA PCR testing in safely reducing vancomycin use in intensive care settings.
• To provide the first randomized controlled trial data on MRSA nasal swab PCR testing for antibiotic de-escalation.
• To assess the impact of MRSA PCR testing and stewardship guidance on clinical outcomes.

Main Methods:

• Pragmatic, prospective, single-center, non-blinded randomized trial (STOP-Vanc).
• Adult patients with suspected CAP receiving vancomycin in the Medical Intensive Care Unit were randomized (1:1) to MRSA PCR testing plus usual care or usual care alone.
• Primary outcome: vancomycin-free hours alive within 7 days; secondary outcomes: 30-day mortality and time alive off vancomycin.

Main Results:

• Primary outcome: vancomycin-free hours alive within 7 days.
• Secondary outcomes: 30-day all-cause mortality and time alive off vancomycin.
• Data on vancomycin de-escalation and clinical outcomes will be reported.

Conclusions:

• The STOP-Vanc trial will offer crucial randomized data on using MRSA nasal swab PCR testing to guide antibiotic de-escalation.
• Findings will inform antimicrobial stewardship practices and clinical decision-making in intensive care units for CAP management.