Evaluation of a clinical pharmacist-led antimicrobial stewardship program in a neurosurgical intensive care unit: a pre-and post-intervention cohort study

被引:1
|
作者
Yu, Jing [1 ,2 ]
Liu, Yan [1 ,2 ]
Qu, Ruochen [1 ,2 ]
Wang, Ziyang [3 ]
Zhao, Yan [1 ,2 ]
Zhao, Yuanyuan [1 ,2 ]
Zhou, Chunhua [1 ,2 ]
机构
[1] Hebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
[2] Hebei Med Univ, Hosp 1, Technol Innovat Ctr Artificial Intelligence Clin P, Shijiazhuang, Peoples R China
[3] Hebei Med Univ, Dept Clin Pharm, Shijiazhuang, Peoples R China
关键词
microbial; mortality; antimicrobial stewardship; neurosurgical intensive care units; drug resistance; INFECTIOUS-DISEASES SOCIETY; CRITICALLY-ILL PATIENTS; MULTICENTER; MENINGITIS; GUIDELINES; MANAGEMENT; GUIDANCE; AMERICA;
D O I
10.3389/fphar.2023.1263618
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Background: Antimicrobial resistance poses a significant challenge in neurosurgical intensive care units (ICU). The excessive use of broad-spectrum antibiotics is closely linked to the emergence and dissemination of drug-resistant bacteria within neurosurgical ICUs. This study assessed the effects of implementing a comprehensive Antimicrobial Stewardship (AMS) program in a neurosurgical ICU setting.Methods: From April 2022 to September 2022, an AMS program was implemented in the neurosurgical ICU. The program involved the regular presence of a pharmacist and an infectious disease physician who conducted prospective audits and provided feedback. To assess the impact of the AMS program, the outcome measures were compared between the AMS period and the 6 months before AMS implementation (pre-AMS period). The primary outcome was the use of antibacterial agents, including anti-pseudomonal beta-lactams (APBLs), polymyxin, and tigecycline. Additionally, the study evaluated the appropriateness of antimicrobial de-escalation and the susceptibility of Gram-negative bacilli to antimicrobial agents.Results: A total of 526 were included during the AMS period, while 487 patients were included in the pre-AMS period. The two groups had no significant differences in disease severity and mortality rates. During the AMS period, there was a notable decrease in the use of APBLs as empiric treatment (43.92% vs. 60.99%, p < 0.001). Multi-drug resistant organism (MDRO) infections decrease significantly during AMS period (11.03% vs. 18.48%, p < 0.001). The number of prescription adjustment increased significantly in all patients (0 item vs. 0 item, p < 0.001) and MDRO-positive patients (3 items vs. 2 items, p < 0.001) during the AMS period. Additionally, appropriate antimicrobial de-escalation for patients with MDRO showed improvement during the AMS period (39.66% vs. 20%, p = 0.001). Polymyxin utilization also decreased during the AMS period (15.52% vs. 31.11%, p = 0.034). Furthermore, the susceptibility of Gram-negative Bacilli isolates to APBLs was significantly higher during the AMS period.Conclusion: Implementing a comprehensive pharmacist-led AMS program led to a decrease in the use of antibacterial agents. This reduction in usage is significant because it can potentially delay the emergence of bacterial resistance.
引用
收藏
页数:10
相关论文
共 50 条
  • [21] Impact of clinical pharmacist-led intervention for drug-related problems in neonatal intensive care unit a randomized controlled trial
    Yalcin, Nadir
    Kasikci, Merve
    Celik, Hasan Tolga
    Allegaert, Karel
    Demirkan, Kutay
    Yigit, Sule
    FRONTIERS IN PHARMACOLOGY, 2023, 14
  • [22] Correction to: Expanding Antimicrobial Stewardship to Urgent Care Centers Through a Pharmacist-Led Culture Follow-up Program
    Lisa E. Dumkow
    Thomas S. Beuschel
    Kasey L. Brandt
    Infectious Diseases and Therapy, 2017, 6 : 565 - 565
  • [23] The PROMISING Project: A Pilot Study to Improve Geriatric Care Through a Pharmacist-Led Psychotropic Stewardship Program
    d'Amours, Marie
    Ettis, Farah
    Ginefri, Lauriane
    Lim, Johnny
    Yuan, Angela-Sinlan Lin Poo
    Fontaine, Jennifer
    Wazzan, Dana
    Williamson, David
    Dagenais-Beaule, Vincent
    DRUGS & AGING, 2023, 40 (11) : 1037 - 1045
  • [24] The PROMISING Project: A Pilot Study to Improve Geriatric Care Through a Pharmacist-Led Psychotropic Stewardship Program
    Marie d’Amours
    Farah Ettis
    Lauriane Ginefri
    Johnny Lim
    Angela-Sinlan Lin Poo Yuan
    Jennifer Fontaine
    Dana Wazzan
    David Williamson
    Vincent Dagenais-Beaulé
    Drugs & Aging, 2023, 40 : 1037 - 1045
  • [25] Clinical Pharmacist Led Intervention with Carbapenem Antibiotics in Intensive Care Unit (ICU): a Real World Study
    Liu, Dong
    Huang, Yan
    Ding, Zheng
    LATIN AMERICAN JOURNAL OF PHARMACY, 2022, 41 (06): : 1200 - 1204
  • [26] Correction to: Clinical and economic effects of an antimicrobial stewardship intervention in a surgical intensive care unit
    Hartmut Stocker
    Cornelia Mehlhorn
    Kati Jordan
    Leila Eckholt
    Laura Jefferys
    Keikawus Arastéh
    Infection, 2020, 48 : 521 - 521
  • [27] Evaluation of the impact of pharmacist-led medication reconciliation intervention: a single centre pre-post study from Ethiopia
    Mekonnen, Alemayehu B.
    McLachlan, Andrew J.
    Brien, Jo-anne E.
    Mekonnen, Desalew
    Abay, Zenahbezu
    INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, 2018, 40 (05) : 1209 - 1216
  • [28] EVALUATION OF THE INTRODUCTION OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM TO A MEDICAL-SURGICAL INTENSIVE CARE UNIT
    Burry, L.
    Howie, S.
    Lapinsky, S.
    Khory, T.
    Minnema, B.
    Christian, M.
    Stewart, T.
    Wax, R.
    Mehta, S.
    Thomson, M.
    Bell, C.
    Morris, A.
    INTENSIVE CARE MEDICINE, 2010, 36 : S199 - S199
  • [29] Evaluation of a post-discharge pharmacist opioid review following total knee arthroplasty: a pre- and post-intervention cohort study
    Tran, Tim
    Ford, James
    Hardidge, Andrew
    Antoine, Shari
    Veevers, Beth
    Taylor, Simone
    Elliott, Rohan A.
    INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, 2022, 44 (06) : 1269 - 1276
  • [30] Evaluation of a post-discharge pharmacist opioid review following total knee arthroplasty: a pre- and post-intervention cohort study
    Tim Tran
    James Ford
    Andrew Hardidge
    Shari Antoine
    Beth Veevers
    Simone Taylor
    Rohan A. Elliott
    International Journal of Clinical Pharmacy, 2022, 44 : 1269 - 1276