Hospital policies and practices on prevention and treatment of infections caused by methicillin-resistant Staphylococcus aureus.
OBJECTIVE
The use of policies and practices regarding surveillance, decolonization, and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections and the formulary status of various antimicrobial agents used to treat MRSA were characterized.


METHODS
A 61-item questionnaire was sent to the director of pharmacy at each of 263 acute care hospitals that were members of a national group purchasing organization.


RESULTS
Responses were received from 102 hospitals (38.8%). Active surveillance culture protocols were in place at 44 hospitals (44%). Nearly 75% engaged in key antimicrobial stewardship activities, while only 18% reported having a formal antimicrobial stewardship team. MRSA decolonization policies existed in approximately 25% of the respondent hospitals. Vancomycin was on the formulary in all hospitals with few restriction policies, while the newer anti-MRSA agents-linezolid, daptomycin, and tigecycline-were on the formulary in most hospitals but with restrictions. Vancomycin was the most commonly used antimicrobial for the treatment of various MRSA infections, followed by linezolid. Nearly 70% of the respondent hospitals reported having a vancomycinspecific dosing or monitoring guideline in place. Most specified the use of actual body weight for dosing and trough serum concentrations at steady state for therapeutic monitoring (84% and 91%, respectively). Most guidelines did not address the use of a loading dose to attain a high target trough or methods for choosing alternative agents.


CONCLUSIONS
Acute care hospitals in the United States varied in their policies and practices of surveillance, decolonization, and treatment of MRSA infections, but most were consistent with national guideline recommendations.
Center for Pharmacoeconomic Research, University of Illinois at Chicago, 60612, USA.
Yoojung
Y
Yang
Martin V
MV
McBride
Keith A
KA
Rodvold
Frank
F
Tverdek
Anne Marie
AM
Trese
Joel
J
Hennenfent
Gordon
G
Schiff
Bruce L
BL
Lambert
Glen T
GT
Schumock
D000081:Acetamides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D017576:Daptomycin / Q000627:therapeutic use; D005572:Formularies, Hospital as Topic; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006761:Hospitals; D006801:Humans; D017053:Infection Control; D000069349:Linezolid; D055624:Methicillin-Resistant Staphylococcus aureus; D008911:Minocycline / Q000031:analogs & derivatives / Q000627:therapeutic use; D016134:Organizational Policy; D023303:Oxazolidinones / Q000627:therapeutic use; D010356:Patient Isolation; D010607:Pharmacy Service, Hospital; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D000078304:Tigecycline; D014640:Vancomycin / Q000627:therapeutic use
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000078304:Tigecycline; D008911:Minocycline; D000069349:Linezolid; D017576:Daptomycin