Apisarnthanarak Anucha, Lapcharoen Pimpun, Vanichkul Pitcha, Srisaeng-Ngoen Tananat, Mundy Linda M
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Pharmacy Unit, Thammasat University Hospital, Pratumthani, Thailand.
Am J Infect Control. 2015 Sep 1;43(9):956-9. doi: 10.1016/j.ajic.2015.05.011. Epub 2015 Jun 19.
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).
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.
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.
Our study suggests measurable treatment benefits associated with international IDCP training and the integration of adjunct IDCP services into hospital-based ASPs.
本研究旨在设计并评估由经过培训的医院感染病临床药师（IDCP）强化抗生素管理计划（ASP）的效果。
IDCP培训由3名药师开展，为期12小时。2012年1月1日至2012年9月30日，对6个内科病房所有因疑似感染而连续入院的患者进行前瞻性随访直至出院。标准治疗（SoC）包括采用或不采用感染病会诊（IDC）的ASP措施。医师团队可选择请求IDC、IDCP或两者皆有。IDCP的支持包括药师参与每日查房以提供抗生素使用信息。所考察的结局包括不适当的抗生素使用、抗生素降阶梯治疗、抗生素使用时长以及住院时间（LOS），并按接受SoC与接受有或无IDC的辅助IDCP服务的患者组进行分层。
SoC组有150例患者，IDCP组有104例，IDCP加IDC组有320例。大多数抗生素处方用于经验性治疗（n = 373，65%），最常见的指征是呼吸道感染（n = 287，50%）和尿路感染（n = 165，29%）。通过多变量分析，与SoC相比，其他两组开具不适当抗生素使用的可能性较小（P <.001），进行了抗生素降阶梯治疗（P <.001），接受抗生素治疗的时间<7天（P <.001），且患者的住院LOS较短（P <.001）。各组在死亡率方面无差异。
我们的研究表明，国际IDCP培训以及将辅助IDCP服务纳入医院ASP可带来可衡量的治疗益处。
