Imaura Masaharu, Kohata Yuji, Kobayashi Koutarou, Takahashi Hiroyuki, Yokoyama Haruko, Akase Tomohide, Yamada Yasuhiko
Department of Pharmacy, Saiseikai Yokohamashi Tobu Hospital, Tsurumi-ku, Yokohama, Japan.
Yakugaku Zasshi. 2011 Apr;131(4):563-70. doi: 10.1248/yakushi.131.563.
Pharmacists are providing pharmaceutical care in general wards, but it is still not common in the intensive care unit (ICU). However, we have worked in ICU, and recommended the rational dosage regimen of the antibiotics to the physicians during the treatment period. Especially, the patients who were infected with methicillin-resistant Staphylococcus aureus (MRSA) in ICU should be provided appropriate antibiotic therapy, otherwise they have a poor prognosis. The aim of this study is to evaluate usefulness of the pharmacists' intervention on the antibiotic therapy for MRSA infectious diseases in the ICU. We investigated retrospectively the period of anti MRSA drugs administration, the medical cost, which includes cost of anti MRSA drugs and hospital charge, and the initial trough concentration of vancomycin (VCM). The patients with MRSA pneumonia were classified into two groups according to the pharmacists' intervention. The number of the patients who the pharmacists performed dosage regimen of anti MRSA drug was 11 (intervention group) and that of the patients who the pharmacists performed no intervention was 47 (control group). The average period of administration of anti MRSA drugs in the intervention group was significantly decreased in 5 days. Furthermore, if the pharmacists performed dosage regimen of anti MRSA drug to the patients in control group, the medical cost of 10 million yen would be saved. The initial trough concentrations of VCM were not significantly different between two groups. However, the achievement rates are 75.0% in intervention group and 66.7% in control group, if the goal of trough level of VCM is set from 5 to 15 µg/ml. Moreover, there are 75.0% in intervention group and 20.8% in control group, if the goal of trough level of VCM is set from 10 to 20 µg/ml, which is significantly different between the two groups. Therefore, it was suggested that the pharmacists in the ICU contributed to optimize the anti MRSA therapy and reduce the medical cost.
药剂师在普通病房提供药学服务，但在重症监护病房（ICU）仍不常见。然而，我们曾在ICU工作，并在治疗期间向医生推荐抗生素的合理给药方案。特别是，ICU中感染耐甲氧西林金黄色葡萄球菌（MRSA）的患者应接受适当的抗生素治疗，否则预后较差。本研究的目的是评估药剂师干预对ICU中MRSA感染性疾病抗生素治疗的有效性。我们回顾性调查了抗MRSA药物的给药时间、医疗费用（包括抗MRSA药物费用和住院费用）以及万古霉素（VCM）的初始谷浓度。根据药剂师的干预情况，将MRSA肺炎患者分为两组。药剂师进行抗MRSA药物给药方案调整的患者有11例（干预组），未进行干预的患者有47例（对照组）。干预组抗MRSA药物的平均给药时间显著缩短了5天。此外，如果药剂师对对照组患者进行抗MRSA药物给药方案调整，可节省1000万日元的医疗费用。两组VCM的初始谷浓度无显著差异。然而，如果将VCM谷浓度目标设定为5至15μg/ml，干预组的达标率为75.0%，对照组为66.7%。而且，如果将VCM谷浓度目标设定为10至20μg/ml，干预组为75.0%，对照组为20.8%，两组之间存在显著差异。因此，提示ICU中的药剂师有助于优化抗MRSA治疗并降低医疗费用。
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