Sadeq Ahmed A, Shamseddine Jinan M, Babiker Zahir Osman Eltahir, Nsutebu Emmanuel Fru, Moukarzel Marleine B, Conway Barbara R, Hasan Syed Shahzad, Conlon-Bingham Geraldine M, Aldeyab Mamoon A
Department of Pharmacy, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. BOX 11001, United Arab Emirates.
Division of Infecious Diseases, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. BOX 11001, United Arab Emirates.
Antibiotics (Basel). 2021 Oct 22;10(11):1289. doi: 10.3390/antibiotics10111289.
Antimicrobial stewardship programs (ASP) are an essential strategy to combat antimicrobial resistance. This study aimed to measure the impact of an ASP multidisciplinary team (MDT) escalating intervention on improvement of clinical, microbiological, and other measured outcomes in hospitalised adult patients from medical, intensive care, and burns units. The escalating intervention reviewed the patients' cases in the intervention group through the clinical pharmacists in the wards and escalated complex cases to ID clinical pharmacist and ID physicians when needed, while only special cases required direct infectious disease (ID) physicians review. Both non-intervention and intervention groups were each followed up for six months. The study involved a total of 3000 patients, with 1340 (45%) representing the intervention group who received a total of 5669 interventions. In the intervention group, a significant reduction in length of hospital stay ( < 0.01), readmission ( < 0.01), and mortality rates ( < 0.01) was observed. Antibiotic use of the WHO AWaRe Reserve group decreased in the intervention group (relative rate change = 0.88). Intravenous to oral antibiotic ratio in the medical ward decreased from 4.8 to 4.1. The presented ASP MDT intervention, utilizing an escalating approach, successfully improved several clinical and other measured outcomes, demonstrating the significant contribution of clinical pharmacists atimproving antibiotic use and informing antimicrobial stewardship.
抗菌药物管理计划（ASP）是对抗抗菌药物耐药性的一项重要策略。本研究旨在衡量ASP多学科团队（MDT）逐步升级干预措施对来自内科、重症监护和烧伤科的住院成年患者的临床、微生物学及其他可测量结果改善情况的影响。逐步升级干预措施通过病房临床药师对干预组患者病例进行审查，必要时将复杂病例提交给感染病临床药师和感染病医生，而只有特殊病例需要感染病（ID）医生直接审查。非干预组和干预组均随访6个月。该研究共纳入3000例患者，其中1340例（45%）为干预组，共接受了5669次干预。在干预组中，观察到住院时间（<0.01）、再入院率（<0.01）和死亡率（<0.01）显著降低。干预组中世界卫生组织（WHO）AWaRe储备组的抗生素使用量有所下降（相对率变化=0.88）。内科病房静脉用抗生素与口服抗生素的比例从4.8降至4.1。所提出的ASP MDT干预措施采用逐步升级的方法，成功改善了多项临床及其他可测量结果，证明了临床药师在改善抗生素使用和指导抗菌药物管理方面的重大贡献。
