Thomnoi Teeranuch, Komenkul Virunya, Prawang Abhisit, Santimaleeworagun Wichai
Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand.
Pharmaceutical Initiative for Resistant Bacteria and Infectious Diseases Working Group (PIRBIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand.
Antibiotics (Basel). 2022 Jun 2;11(6):760. doi: 10.3390/antibiotics11060760.
Few studies have analyzed community hospital-based parenteral anti-infective therapy (CohPAT). We aimed to assess the clinical impact of a pharmacist-led implementation of a clinical practice guideline (CPG) for CohPAT, and to determine the pharmacist's role in CohPAT medication management. The prospective-period patients (post-implementation group) were compared with the historical control-period patients (pre-implementation group) for receiving a continuous antimicrobial parenteral injection. A CPG was used for laboratory testing for efficacy and safety, the monitoring of adverse drug events during admission, microbiology results coordination, and dosage adjustment. For any antimicrobial drug-related problems, the pharmacist consulted with the clinicians. Over 14 months, 50 participants were included in each group. In the pre-implementation period, 7 (14%) and 4 (8%) out of 50 patients received an inappropriate dosage and nonlaboratory monitoring for dose adjustment, respectively. The patients received the proper dosage of antimicrobial agents, which increased significantly from 78% pre- to 100% post-implementation ( = 0.000). The pharmacist's interventions during the prospective-period were completely accepted by the clinicians, and significantly greater laboratory monitoring complying with CPG was given to the postimplementation group than the pre-implementation group (100% vs. 60%; = 0.000). Significantly less patients with unfavorable outcomes (failure or in-hospital mortality) were observed in the post-implementation than in the pre-implementation (6% vs. 26%; = 0.006) group. For the logistic regression analysis, lower respiratory infection (adjusted OR, aOR 3.68; 95%CI 1.13-12.06) and the post-implementation period (aOR 0.21; 95%CI 0.06-0.83) were significant risk factors that were associated with unfavorable outcomes. Given the better clinical outcomes and the improved quality of septic patient care observed after implementation, pharmacist-led implementation should be adopted in healthcare settings.
很少有研究分析基于社区医院的肠外抗感染治疗（CohPAT）。我们旨在评估由药剂师主导实施CohPAT临床实践指南（CPG）的临床影响，并确定药剂师在CohPAT药物管理中的作用。将前瞻性时期的患者（实施后组）与历史对照时期的患者（实施前组）进行比较，以观察接受持续抗菌药物肠外注射的情况。使用CPG进行疗效和安全性的实验室检测、住院期间药物不良事件的监测、微生物学结果协调以及剂量调整。对于任何与抗菌药物相关的问题，药剂师会与临床医生进行咨询。在14个月的时间里，每组纳入50名参与者。在实施前阶段，50名患者中有7名（14%）和4名（8%）分别接受了不适当的剂量以及未进行实验室监测以调整剂量。患者接受了适当剂量的抗菌药物，从实施前的78%显著增加到实施后的100%（P = 0.000）。前瞻性时期药剂师的干预措施完全被临床医生接受，并且实施后组比实施前组有显著更多的符合CPG的实验室监测（100%对60%；P = 0.000）。实施后观察到不良结局（治疗失败或院内死亡）的患者明显少于实施前（6%对26%；P = 0.006）组。对于逻辑回归分析，下呼吸道感染（调整后的比值比，aOR 3.68；95%置信区间1.13 - 12.06）和实施后时期（aOR 0.21；95%置信区间0.06 - 0.83）是与不良结局相关的显著危险因素。鉴于实施后观察到更好的临床结局以及脓毒症患者护理质量的改善，医疗环境中应采用由药剂师主导的实施方式。
