2026 Southeastern Residency Conference

Lauryn Malone, Ben Casey, Darby Siler 
TriStar Centennial Medical Center – Nashville, TN 

Background: Febrile neutropenia (FN) is a common complication of cancer treatment and is considered to be an oncologic emergency. Vancomycin is primarily used to treat infections caused by methicillin-resistant Staphylococcus aureus. FN guidelines do not recommend routine use of MRSA coverage as empiric therapy for FN unless pre-specified criteria are fulfilled. Despite these recommendations, previous studies suggest vancomycin is often prematurely added to empiric antibiotic therapy regimens in patients with febrile neutropenia. Utilization of vancomycin empirically in FN has been increasing, though its clinical utility remains uncertain due to the lower incidence of resistant gram-positive organisms causing FN. The purpose of this study was to evaluate the utilization and prescribing patterns of empiric vancomycin for febrile neutropenia at our facility. 
 
Methods: Patients were identified based on having vancomycin ordered for the indication of febrile neutropenia. Patients were included if they had a fever and were neutropenic. Exclusion criteria consisted of patients ages 18 years of age or younger, patients receiving care under the pediatric oncology service, patients without a diagnosis of cancer, and patients with vancomycin ordered for less than 24 hours. The primary outcome was to evaluate the incidence of guideline-directed utilization of empiric vancomycin for febrile neutropenia. Secondary outcomes included the duration of fever, appropriateness of gram-positive and gram-negative coverage, incidence of positive blood cultures, and prescribing patterns among various specialties. Descriptive statistics were used to report outcomes. 
 
Results: A total of 153 patients were screened; 38 patients met inclusion criteria, and 115 patients were excluded due to receiving vancomycin for less than 24 hours. Of the 38 patients included, 89% (n =34) had hematologic malignancies, with a cohort age range of 28–80 years. Among the 38 patients evaluated, 26 (68%) received empiric MRSA coverage consistent with established FN guidelines. The most common indication for empiric vancomycin was concerns for pneumonia on imaging (13/38 patients; 34%). The average duration of MRSA coverage was 93.8 hours (SD: 63.7 hours). Emergency medicine providers initiated empiric vancomycin for 17/38 patients (45%). No adverse reactions were noted for included patients.
 
Conclusions: This study found that in patients presenting with FN who were empirically started on vancomycin, therapy was routinely discontinued within 24 hours. This study also found that in patients who received vancomycin for greater than 24 hours, vancomycin utilization was discordant with guideline recommendations for MRSA directed therapy in FN, highlighting the potential need for antimicrobial stewardship intervention for this patient population. 
 
This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.