Background: Oral linezolid is a broad-spectrum oxazolidinone antibiotic that offers advantages compared to intravenous (IV) vancomycin including no requirement for therapeutic drug monitoring, no need for home health or peripherally inserted central catheter (PICC) line placement, and opportunities for earlier hospital discharge due to the ease of continuing therapy outpatient. A medication use evaluation investigated if opportunities existed for oral linezolid over IV vancomycin among a randomized cohort of 100 patients initiated on IV vancomycin. Reviewers identified 15 patients who were candidates for transition to oral linezolid and calculated a potential cost avoidance of 125perdayofantibiotictherapy.ThepurposeofthisstudyistoassessthefeasibilityofimplementinganinterdisciplinaryapproachfortransitioningIVvancomycintoorallinezolidbasedonpharmacist−ledtransitioncriteria.Methods:ThisisanIRB−reviewed,single−center,quasi−experimentalstudyatBaptistHospitalofMiami,a900−bedtertiarycommunityhospital.Includedpatientswere3˘e18yearsold,receivingIVvancomycinfor3˘e48hours,andadmittedbetweenJanuary10,2023andMarch31,2023.Patientswereexcludediftheyhadanactivevasopressororder,wereimmunocompromised,orifthepatientwasreceivingantibioticsformeningitis,endocarditis,febrileneutropenia,orsurgicalprophylaxis.Apharmacyresidentwason−calltoassessfororallinezolidcandidatesusingantibiotictimeoutcriteriaandintervenedasappropriate.ContinuousandcategoricalvariableswereevaluatedusingtheMann−WhitneyUtestandFisher’sexacttest,respectively.TheprimaryoutcomewastotalcostavoidanceinpatientstransitionedfromIVvancomycintoorallinezolid.Secondaryoutcomesincludedmedianhospitallengthofstay,medianantibiotictreatmentdays,andincidenceofthrombocytopeniaandacutekidneyinjury,andpharmacistinterventionacceptancerate.Results:Investigatorsscreened317patientsforstudyinclusionand94patientsmetcriteria.66(705,538, with a total of 21and70 saved per inpatient and outpatient antibiotic treatment day, respectively. Median length of antibiotic treatment days was 6 days between both groups (p=0.3524). No statistically significant differences were observed between length of stay, length of antibiotic treatment days, or safety outcomes between the 2 groups. Acute kidney injury occurred in 1 patient receiving linezolid and 1 patient receiving IV vancomycin. Thrombocytopenia, defined as a \u3e50% drop in platelet count from baseline, occurred in 1 patient receiving provider-driven linezolid therapy.
Conclusion: Pharmacist-driven transition criteria from IV vancomycin to linezolid therapy resulted in a positive cost avoidance strategy, with similar effect on hospital antibiotic treatment days and no difference in incidence of adverse effects. These results demonstrate the practicality of a pharmacist prospective antibiotic timeout and intervention strategy for patients receiving empiric or targeted Methicillin-resistant Staphylococcus aureus (MRSA) therapy