P-640. Vancomycin <i>vs</i> Ceftaroline for Treatment of Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) Pneumonia: A Multicenter Retrospective Study

Abstract Background Vancomycin (V) is considered first-line treatment for MRSA infections, assuming bacterial susceptibility and patient tolerability. Ceftaroline (C) has been used off-label to treat MRSA blood stream infections, osteomyelitis, ventilator-associated pneumonia, hospital-acquired pneumonia and endocarditis. However, the efficacy of C vs V for treatment of MRSA pneumonia has not been studied.Figure 1.Summary of Exclusions for Patient Population Methods Data was extracted from a centralized database for 184 HCA Healthcare hospitals from January 1st, 2016 – June 30th, 2023. Patient encounters with a diagnostic code of MRSA pneumonia and received V and/or C were included for further analysis. In-hospital mortality and length of stay (LOS) were the main outcomes studied. Demographics including age, sex and race were extracted. Average vitals values noted included temperature and O2 saturation. Lab values included average WBC count, creatinine and GFR. Time to first dose of V or C from time of admission and time to transition from V to C were included. Patients who received C-only were combined with the patients who first received V and then transitioned to C (VC). IRB approval was obtained prior to data extraction.Table 1.Demographics, Clinical Data and Outcomes Results Initial data extraction yielded 5977 encounters with final analysis for 4511 unique patients. Encounters were excluded for missing demographic data, duplicates or when V or C were not received. The V-only group had 4372 encounters and the C+VC combined group had 139 encounters. The mortality rate in the V-only group was 609/4372 (13.9%), while that in the C+VC group was 31/139 (22.3%). LOS was 13.22 days and 18.45 days in the V only and C+VC groups, respectively. The average time to transition from V to C in the VC group was 6.4 hours with maximum of 34 hours. Average temperature and O2 saturation were not significantly different between the two groups. GFR (mL/min/1.73m2) was 63.86 and 60.30 and WBC (103/µL) count was 11.93 and 14.01 in the V and V+VC groups, respectively. Conclusion Preliminary data suggest that V may be superior to C for MRSA pneumonia with respect to mortality and hospital LOS. Average WBC may be greater in the C+VC group, suggesting more severe illness. Reasons for transition of V to C were unknown, however given the short transition time, the impact of V on treatment outcome is likely negligible. Disclosures All Authors: No reported disclosures