Pharmacy Department, Hamad Medical Corporation, Doha, Qatar.
Pharmacy Department, Hamad Medical Corporation, Doha, Qatar.
Res Social Adm Pharm. 2024 Nov;20(11):1023-1037. doi: 10.1016/j.sapharm.2024.08.006. Epub 2024 Aug 14.
We sought to characterize and evaluate the effectiveness of pharmacist-led AMS interventions in improving antimicrobial use and subsequent surgical site infections (SSI) in perioperative settings.
A systematic review and meta-analysis was conducted by searching PubMed, Embase and CINAHL. Two independent reviewers extracted the data using the Descriptive Elements of Pharmacist Intervention Characterization Tool and undertook quality assessment using the Crowe Critical Appraisal. A meta-analysis was conducted using a random-effect model.
Eleven studies were included in this review. Pharmacists were found to have various roles in AMS, including educational sessions, ward rounds, audits and feedback, and guidelines development. The discussion of interventions lacked details on the development. A meta-analysis revealed that pharmacist-led AMS programs in perioperative settings was associated with a significant improvement in antibiotic selection (OR 4.29; 95 % CI 2.52-7.30), administration time (OR 4.93; 95 % CI 2.05-11.84), duration (OR 5.27; 95 % CI 1.58-17.55), and SSI (OR 0.51; 95 % CI 0.34-0.77).
Pharmacist-led AMS programs were effective in improving antimicrobial prescribing while reducing SSI; however most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions, therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. High-quality, multicomponent, theory-derived, interventional studies using appropriate methodology and standardized data collection, are needed.
我们旨在描述和评估药剂师主导的抗菌药物管理（AMS）干预措施在改善围手术期抗菌药物使用和随后的手术部位感染（SSI）方面的效果。
通过检索 PubMed、Embase 和 CINAHL 进行系统评价和荟萃分析。两名独立审查员使用药剂师干预特征描述工具提取数据，并使用 Crowe 批判性评估进行质量评估。使用随机效应模型进行荟萃分析。
本综述共纳入 11 项研究。药剂师在 AMS 中具有各种角色，包括教育课程、病房查房、审核和反馈以及指南制定。干预措施的讨论缺乏关于开发的详细信息。荟萃分析显示，围手术期的药剂师主导的 AMS 方案与抗生素选择（OR 4.29；95%CI 2.52-7.30）、给药时间（OR 4.93；95%CI 2.05-11.84）、持续时间（OR 5.27；95%CI 1.58-17.55）和 SSI（OR 0.51；95%CI 0.34-0.77）的显著改善相关。
药剂师主导的 AMS 方案在改善抗菌药物处方的同时，降低了 SSI 的发生率，是有效的；然而，大多数研究的质量为中等。这些研究缺乏利用理论来开发干预措施，因此，尚不清楚是否基于理论的干预措施比没有理论元素的干预措施更有效。需要采用适当的方法和标准化数据收集，进行高质量、多组分、基于理论、干预性研究。
