Department of Anesthesiology and Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Intensive Care Unit, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Am J Infect Control. 2017 Sep 1;45(9):983-989. doi: 10.1016/j.ajic.2017.02.021. Epub 2017 Jun 5.
Antimicrobial stewardship programs, particularly pharmacist-driven programs, help reduce the unnecessary use of antimicrobial agents. The objective of this study was to assess the influence of pharmacist-driven antimicrobial stewardship on antimicrobial use, multidrug resistance, and patient outcomes in adult intensive care units in China.
We conducted a multicenter prospective cohort study with a sample of 577 patients. A total of 353 patients were included under a pharmacist-driven antimicrobial stewardship program, whereas the remaining 224 patients served as controls. The primary outcome was all-cause hospital mortality.
The pharmacist-driven antimicrobial stewardship program had a lower hospital mortality rate compared with the nonpharmacist program (19.3% vs 29.0%; P = .007). Furthermore, logistic regression analysis indicated that the pharmacist-driven program independently predicted hospital mortality (odds ratio, 0.57; 95% confidence interval, 0.36-0.91; P = .017) after adjustment. Meanwhile, this strategy had a lower rate of multidrug resistance (23.8% vs 31.7%; P = .037). Moreover, the strategy optimized antimicrobial use, such as having a shorter duration of empirical antimicrobial therapy (2.7 days; interquartile range [IQR], 1.7-4.6 vs 3.0; IQR, 1.9-6.2; P = .002) and accumulated duration of antimicrobial treatment (4.0; IQR, 2.0-7.0 vs 5.0; IQR, 3.0-9.5; P = .030).
Pharmacist-driven antimicrobial stewardship in an intensive care unit decreased patient mortality and the emergence of multidrug resistance, and optimized antimicrobial agent use.
抗菌药物管理计划，尤其是药剂师主导的计划，有助于减少抗菌药物的不必要使用。本研究旨在评估药师主导的抗菌药物管理计划对中国成人重症监护病房抗菌药物使用、多重耐药和患者结局的影响。
我们进行了一项多中心前瞻性队列研究，纳入了 577 名患者。共有 353 名患者接受了药师主导的抗菌药物管理计划，而其余 224 名患者作为对照组。主要结局是全因住院死亡率。
与非药剂师方案相比，药师主导的抗菌药物管理计划的住院死亡率较低（19.3% vs 29.0%；P=0.007）。此外，逻辑回归分析表明，在调整后，该计划独立预测了住院死亡率（优势比，0.57；95%置信区间，0.36-0.91；P=0.017）。同时，该策略的多重耐药率较低（23.8% vs 31.7%；P=0.037）。此外，该策略优化了抗菌药物的使用，例如缩短了经验性抗菌治疗的持续时间（2.7 天；四分位间距[IQR]，1.7-4.6 与 3.0；IQR，1.9-6.2；P=0.002）和累积抗菌治疗时间（4.0；IQR，2.0-7.0 与 5.0；IQR，3.0-9.5；P=0.030）。
重症监护病房中由药剂师主导的抗菌药物管理计划降低了患者死亡率和多重耐药的出现，并优化了抗菌药物的使用。
