Abdelrahman Deema H, AbuSara Aseel K, Khabour Dina S
King Hussein Cancer Center, Amman, Jordan.
Hosp Pharm. 2023 Aug;58(4):392-395. doi: 10.1177/00185787221150920. Epub 2023 Jan 20.
Several antimicrobial stewardship interventions have demonstrated improved clinical outcomes. Though the impact of a pharmacist-led antimicrobial stewardship review of cultures has been described, studies have not evaluated such an intervention in institutions that primarily serve cancer patients. To describe the impact of the antimicrobial stewardship pharmacist's review of microbiological cultures from adult cancer patients in the ambulatory setting. A retrospective study at a comprehensive cancer center that included adult cancer patients with positive microbiological cultures treated in the ambulatory setting, between August 2020 and February 2021. The cultures were reviewed in real time by the antimicrobial stewardship pharmacist, and were assessed for appropriateness of treatment. The number of antimicrobial modifications made, type of modifications, and physicians' acceptance rate were recorded. A total of 661 cultures from 504 patients were reviewed by the pharmacist. The mean age of patients was 58 years ± 16 (SD); most had solid tumors (95%), and 34% were recent recipients of chemotherapy. Among the reviewed cultures, 175 (26%) required antimicrobial therapy modification, with an acceptance rate of 86%. The modifications consisted of changing from non-susceptible to susceptible antimicrobials (n = 95, 54%), initiation (n = 61, 35%), discontinuation (n = 10, 6%), de-escalation (n = 7, 4%), and dose modification (n = 2, 1%) of antimicrobials. Around one fourth of the cultures reviewed by the antimicrobial stewardship pharmacist in the ambulatory setting required interventions to optimize therapy. Future studies should evaluate the impact of these interventions on clinical outcomes.
几种抗菌药物管理干预措施已显示出改善的临床结果。尽管已有研究描述了由药剂师主导的抗菌药物管理对培养结果审查的影响，但尚未有研究评估在主要服务于癌症患者的机构中进行此类干预的效果。描述抗菌药物管理药剂师对门诊成年癌症患者微生物培养结果审查的影响。在一家综合癌症中心进行的一项回顾性研究，纳入了2020年8月至2021年2月期间在门诊接受治疗且微生物培养结果呈阳性的成年癌症患者。抗菌药物管理药剂师对培养结果进行实时审查，并评估治疗的适宜性。记录抗菌药物调整的次数、调整类型以及医生的接受率。药剂师共审查了来自504名患者的661份培养结果。患者的平均年龄为58岁±16（标准差）；大多数患有实体瘤（95%），34%是近期接受化疗的患者。在审查的培养结果中，175份（26%）需要调整抗菌药物治疗，接受率为86%。调整包括从不敏感抗菌药物改为敏感抗菌药物（n = 95，54%）、开始使用（n = 61，35%）、停用（n = 10，6%）、降阶梯（n = 7，4%）以及调整抗菌药物剂量（n = 2，1%）。在门诊环境中，抗菌药物管理药剂师审查的培养结果中约四分之一需要进行干预以优化治疗。未来的研究应评估这些干预对临床结果的影响。
