378. De-escalating Vancomycin in the ICU: Results of the Swab Testing to Optimize Pneumonia treatment with empiric Vancomycin (STOP-Vanc) Randomized Controlled Trial
Abstract
Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is an infrequent, yet commonly feared cause of community-acquired pneumonia (CAP), leading to frequent use of empiric vancomycin. Multiple retrospective studies suggest the use of polymerase chain reaction (PCR) testing to detect MRSA on nasal swabs can be beneficial in guiding de-escalation of vancomycin in CAP treatment. However, there is a lack of randomized controlled trial (RCT) data evaluating the use of MRSA PCR testing for this purpose, and data regarding this use in an intensive care unit (ICU) are limited.Table 1. Baseline Patient Demographics and CharacteristicsFigure 1. Proportion of Subjects Occupying a Given State Over Time Based on Treatment Arm Methods STOP-Vanc is a pragmatic, prospective, single center, non-blinded randomized trial testing the effect of MRSA PCR testing on inappropriate vancomycin use in the ICU. Adult ICU patients with suspicion of CAP were randomized 1:1 to receive usual care either with (intervention) or without (control) the addition of MRSA nares PCR testing following ICU admission. The primary outcome was vancomycin-free hours alive, defined as the expected number of hours alive and free of vancomycin use within the first 7 days of trial enrollment as estimated using a longitudinal proportional odds ratio model adjusted for baseline covariates. Results 277 adult ICU patients were randomized between April 2024 and January 2025. Baseline patient demographics were…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 277 participants or records.
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