Du Qian, Xi Xin, Dong Jie, Zhang Tongyan, Li Dongxuan, Dong Yuzhu, Li Wenjun, Huang Guili, Zhu Jun, Ran Hailong, Gou Jinghui, Chen Cheng, Bai Zhanfeng, Liu Qinglong, Yao Wei, Zhang Lei, Bi Yutian, Liu Songqing
Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Infectious Disease Department, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Front Pharmacol. 2023 Mar 2;14:1128219. doi: 10.3389/fphar.2023.1128219. eCollection 2023.
Infectious disease (ID) consultation can improve multidrug-resistant organism (MDRO) treatment outcomes. However, the impact of clinical pharmacists' ID consultation on MDRO therapy, especially early initiation, has not been reported. In this study, we try to explore the impact of the pharmacist early active consultation (PEAC) on MDRO patient management. We conducted a prospective historical controlled study based on PEAC in MDRO patients. The retrospective control group was patients hospitalized 18 months before the PEAC initiation, and the prospective PEAC group was patients hospitalized 18 months after the PEAC initiation. Primary endpoint was 30-day all-cause mortality. Secondary outcomes were MDRO clinical outcome, duration of antibiotic use, length of stay, antibiotic consumption and antibiotic costs. Further subgroup analysis of secondary outcomes was performed by the condition at admission, MDRO pathogenicity and MDRO clinical outcome. 188 MDRO patients were included. After adjusting for potential predictors, PEAC reduced the 30-day all-cause mortality by 70% (HR 0.30, 95% CI 0.09-0.96, = 0.042). PEAC group had clinical improvement than control group (89.47% vs. 65.59%, < 0.001), especially in patients with non-severe clinical conditions at admission (98.41% vs. 70.18%, < 0.001). However, no significant differences were found between groups in length of stay, antibiotics consumption, and antibiotics costs. Early active pharmacy ID consultation can reduce 30-day all-cause mortality and improve clinical outcomes in MDRO patients.
感染病（ID）会诊可改善多重耐药菌（MDRO）的治疗效果。然而，临床药师的ID会诊对MDRO治疗的影响，尤其是早期启动会诊的影响，尚未见报道。在本研究中，我们试图探讨药师早期主动会诊（PEAC）对MDRO患者管理的影响。我们对MDRO患者进行了一项基于PEAC的前瞻性历史对照研究。回顾性对照组为PEAC启动前18个月住院的患者，前瞻性PEAC组为PEAC启动后18个月住院的患者。主要终点是30天全因死亡率。次要结局包括MDRO临床结局、抗生素使用时间、住院时间、抗生素消耗量和抗生素费用。根据入院时的病情、MDRO致病性和MDRO临床结局对次要结局进行进一步亚组分析。共纳入188例MDRO患者。在对潜在预测因素进行校正后，PEAC使30天全因死亡率降低了70%（HR 0.30，95%CI 0.09 - 0.96，P = 0.042）。PEAC组的临床改善情况优于对照组（89.47%对65.59%，P < 0.001），尤其是入院时临床病情不严重的患者（98.41%对70.18%，P < 0.001）。然而，两组在住院时间、抗生素消耗量和抗生素费用方面未发现显著差异。早期主动的药学ID会诊可降低MDRO患者的30天全因死亡率并改善临床结局。
