Design and analysis of a pharmacist-enhanced antimicrobial stewardship program in Thailand
Design and analysis of a pharmacist-enhanced antimicrobial stewardship program in Thailand
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DOI：
10.1016/j.ajic.2015.05.011
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发表时间：
2015-09-01
影响因子：
4.9
通讯作者：
Mundy, Linda M.
中科院分区：
文献类型：
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作者：
Apisarnthanarak, Anucha;Lapcharoen, Pimpun;Mundy, Linda M.
背景：本研究的目的是设计和评估训练有素的医院传染病临床药剂师（IDCPs）加强抗生素管理计划（ASP）。方法：由3名药师进行为期12学时的IDCP培训。2012年1月1日至2012年9月30日，对6个医学单位连续收治的推定感染患者进行前瞻性随访至出院。护理标准（SoC）包括有或没有传染病咨询（idc）的ASP措施。医生团队可以选择要求IDCs、idcp或两者兼而有之。IDCP的支持包括药剂师参与每日查房，告知抗生素使用情况。检查的结果是不适当的抗生素使用、抗生素降级、抗生素使用持续时间和住院时间（LOS），这些结果是根据接受SoC与辅助idcp（有和没有idcp）的患者组进行分层的。结果：SoC组150例，IDCP组104例，IDCP + IDC组320例。抗生素处方以经验性治疗为主（n = 3773，占65%），适应证最多的是呼吸道感染（n = 287，占50%）和泌尿道感染（n = 165，占29%）。通过多因素分析，与SoC相比，其他2组被开具不当抗生素处方的可能性较小（P < .001），抗生素用量减少（P < .001），抗生素使用时间< 7天（P < .001），医院损失较短（P < .001）。死亡率没有组间差异。结论：我们的研究表明，与国际IDCP培训和将辅助IDCP服务整合到基于医院的asp中相关的可测量的治疗效益。感染控制与流行病学专业人员协会版权所有Elsevier Inc.出版。版权所有。
Background: The purpose of this study was to design and evaluate the enhancement of an antibiotic stewardship program (ASP) with trained hospital-based infectious diseases clinical pharmacists (IDCPs).Methods: The IDCP training entailed a 12-hour course by 3 pharmacists. From January 1, 2012-September 30, 2012, all patients consecutively admitted with presumptive infections to 6 medicine units were prospectively followed to discharge. Standard of care (SoC) included ASP measures with or without infectious diseases consultations (IDCs). Physician teams had the option to request IDCs, IDCPs, or both. The IDCP support included pharmacist participation in daily rounds to inform on antibiotic use. Outcomes examined were inappropriate antibiotic use, antibiotic de-escalation, duration of antibiotic use, and hospital length of stay (LOS) stratified by patient groups who received SoC versus adjunctive IDCPs with and without IDCs.Results: There were 150 patients in the SoC group, 104 in the IDCP group, and 320 in the IDCP plus IDC group. Most antibiotic prescriptions were for empirical therapy (n = 373, 65%), and the top-ranked indications were infections of the respiratory tract (n = 287, 50%) and urinary tract (n = 165, 29%). By multivariate analysis, compared with SoC, the 2 other groups were less likely to be prescribed inappropriate antibiotic use (P < .001), had de-escalation of antibiotics (P < .001), received antibiotics < 7 days (P < .001), and had subjects with shorter hospital LOSs (P < .001). There were no group differences in mortality.Conclusion: Our study suggests measurable treatment benefits associated with international IDCP training and the integration of adjunct IDCP services into hospital-based ASPs. Copyright (C) 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.