Pharmacy Department, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China; Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China; International Cooperation & Joint Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China.
Pharmacy Department, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China.
Aust Crit Care. 2023 Nov;36(6):933-939. doi: 10.1016/j.aucc.2022.12.011. Epub 2023 Feb 19.
The importance of optimising antimicrobial therapy is highlighted in the hospital intensive care unit (ICU) patients. But roles of ICU pharmacists are still in its infancy in China.
This study's objective was to evaluate the values of clinical pharmacist interventions in the antimicrobial stewardship (AMS) on ICU patients with infections.
The aim of this study was to evaluate the value of clinical pharmacist interventions in the antimicrobial stewardship (AMS) in critically ill patients with infections.
From 2017 to 2019, a propensity score matching retrospective cohort research was conducted on critically ill patients with infectious illnesses. The trial was split into groups that received pharmacist assistance and those who did not. Baseline demographics, pharmacist actions, and clinical results were compared between the two groups. Factors influencing mortality were demonstrated using univariate analysis and bivariate logistic regression. The State Administration of Foreign Exchange in China monitored the exchange rate between the RMB and the US dollar and also gathered the charges of the agents as an economic indicator.
Out of the 1523 patients who were evaluated, 102 critically ill patients with infectious diseases were included in each group after matching. The top five prescription regimens adjusted were settled by sickness progression, microbiological results, de-escalation, drug withdrawal, and therapeutic drug monitoring suggestions. The pharmacist exposure group's antibiotic use density (AUD) decreased significantly (p = 0.018) compared to the control group, going from 241.91 to 176.64 defined daily doses/100 bed days. Following pharmacist interventions, the AUD proportion for carbapenems dropped from 23.7 to 14.43%, while for tetracyclines, it dropped from 11.5 to 6.26%. In the group exposed to the pharmacist, the median cost of antibiotics decreased significantly from $836.3 to $362.15 per patient stay (p < 0.001), and the median cost of all medications dropped from $2868.18 to $1941.5 per patient stay (p = 0.06). RMB was converted into US dollars according to the current exchange rate. According to univariate analyses, pharmacist interventions did not differ between the groups that survived and died (p = 0.288).
This study showed that antimicrobial stewardship had a significant financial return on investment without raising the mortality rate.
在医院重症监护病房（ICU）患者中，优化抗菌治疗的重要性得到了强调。但 ICU 药师的作用在中国仍处于起步阶段。
本研究旨在评估临床药师干预在 ICU 感染患者抗菌药物管理（AMS）中的价值。
2017 年至 2019 年，对感染性疾病重症患者进行了一项倾向评分匹配回顾性队列研究。试验分为接受药师协助组和未接受药师协助组。比较两组患者的基线人口统计学资料、药师干预措施和临床结局。采用单因素分析和二变量逻辑回归分析影响死亡率的因素。中国国家外汇管理局监测人民币兑美元汇率，并收集药物代理商的收费作为经济指标。
在评估的 1523 名患者中，匹配后每组各有 102 名感染性疾病重症患者纳入研究。调整后前五位处方方案为疾病进展、微生物学结果、降级、停药和治疗药物监测建议。药师干预组抗生素使用密度（AUD）显著下降（p=0.018），从 241.91 降至 176.64 定义日剂量/100 床日。经过药师干预，碳青霉烯类药物的 AUD 比例从 23.7%降至 14.43%，而四环素类药物的 AUD 比例从 11.5%降至 6.26%。在接触药师的组中，每位患者的抗生素费用中位数从 836.3 美元降至 362.15 美元（p<0.001），每位患者的所有药物费用中位数从 2868.18 美元降至 1941.5 美元（p=0.06）。人民币按照当前汇率换算成美元。根据单因素分析，存活组和死亡组的药师干预措施没有差异（p=0.288）。
本研究表明，抗菌药物管理具有显著的投资回报，而不会增加死亡率。
