College of Pharmacy, Wonkwang University, Iksan, Korea.
J Clin Pharm Ther. 2022 Apr;47(4):430-444. doi: 10.1111/jcpt.13553. Epub 2021 Oct 30.
Antibiotic stewardship programmes (ASPs) are introduced to ensure effective antibiotic use. Pharmacists can be involved in ASPs to facilitate the appropriate antibiotic use. Prolonged use of antibiotics causes adverse events in critically ill neonates. Hence, this systematic review and meta-analysis was aimed at investigating pharmacists' functions in ASPs in critically ill neonates and the effect of ASP implementation on antibiotic use.
A comprehensive search of PubMed/Medline, Embase, and Cochrane Library databases until January 2021 was conducted and studies that reported the functions of pharmacists in ASPs for critically ill neonates and the results of ASP implementation were included in this review. All processes were performed by two reviewers independently, and any discordance between the two was resolved by discussion.
In all, 19 studies were included in this review. Pharmacists were found to have various functions in ASPs, such as participating in the development of antibiotic use guidelines, auditing antibiotic prescriptions, participating in multidisciplinary ward rounds, educating other ASP team members, checking blood culture or laboratory data, and monitoring antibiotic use. A meta-analysis revealed that ASP implementation in critically ill neonates was significantly associated with a 23% reduction in the overall antibiotic use rate (ratio of means: 0.77, 95% confidence interval: 0.69-0.87, p < 0.001). Moreover, the overall duration of antibiotic therapy significantly reduced by 15% with ASP implementation (ratio of means: 0.85, 95% confidence interval: 0.78-0.91, p < 0.001).
The implementation of ASPs involving pharmacists, especially in critically ill neonates, was associated with the reduced use and duration of antibiotic treatment. Thus, pharmacists played a key role in ASPs in critically ill neonates.
抗生素管理计划（ASPs）旨在确保抗生素的合理使用。药剂师可以参与 ASP 以促进抗生素的合理使用。抗生素的长期使用会导致危重新生儿出现不良事件。因此，本系统评价和荟萃分析旨在调查药剂师在危重新生儿 ASP 中的作用，以及 ASP 实施对抗生素使用的影响。
全面检索 PubMed/Medline、Embase 和 Cochrane Library 数据库，检索时间截至 2021 年 1 月，纳入报道了药剂师在危重新生儿 ASP 中作用以及 ASP 实施结果的研究。所有过程均由两位评审员独立进行，如果两位评审员之间存在分歧，则通过讨论解决。
本综述共纳入 19 项研究。研究发现，药剂师在 ASP 中有多种作用，如参与制定抗生素使用指南、审核抗生素处方、参与多学科病房查房、教育其他 ASP 团队成员、检查血培养或实验室数据以及监测抗生素使用。荟萃分析显示，ASP 实施与危重新生儿总体抗生素使用率降低 23%显著相关（均数比：0.77，95%置信区间：0.69-0.87，p<0.001）。此外，ASP 实施使抗生素治疗总持续时间缩短 15%（均数比：0.85，95%置信区间：0.78-0.91，p<0.001）。
实施包含药剂师的 ASP，特别是在危重新生儿中，与抗生素使用和治疗持续时间的减少相关。因此，药剂师在危重新生儿 ASP 中发挥着关键作用。
