Gatechan Tipanong, Nakaranurack Chotirat, Plongla Rongpong, Chuenjit Thanawan, Gross Alan Edward
Clinical Pharmacy Unit, Department of Pharmacy, Sunprasitthiprasong Hospital, Ubon Ratchatani, Thailand.
Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
J Pharm Policy Pract. 2025 Feb 28;18(1):2467456. doi: 10.1080/20523211.2025.2467456. eCollection 2025.
Critical illness can affect antimicrobial pharmacokinetics and pharmacodynamics. Antimicrobial stewardship programs promote appropriate antimicrobial usage. This study aimed to compare the appropriateness of antibiotic dosing, therapeutic drug monitoring, and ICU mortality before and after antimicrobial stewardship program implementation in medical intensive care units.
This retrospective study was conducted at King Chulalongkorn Memorial Hospital, Thailand. Adults admitted to medical intensive care units from August 1, 2019, to July 31, 2021, who received selected antibiotics in the antimicrobial stewardship program were included. During the intervention period, general education as well as prospective audit with intervention and feedback were implemented by infectious disease pharmacist and clinical pharmacists. The appropriateness of dosing, therapeutic drug monitoring, and ICU mortality were compared before and after antimicrobial stewardship program implementation.
There were 269 patients (455 prescriptions) and 376 patients (604 prescriptions) in the pre- and post-antimicrobial stewardship program implementation groups, respectively. Meropenem was the commonly prescribed antibiotic in both groups. Overall, the appropriateness of dosing and therapeutic drug monitoring improved after antimicrobial stewardship program implementation (36% to 63.58%, < 0.001). Infectious disease and clinical pharmacists provided 40 interventions with an 87.5% acceptance rate. The most common recommendation was maintenance dose adjustment (79.17% acceptance rate). ICU mortality (29.37% to 18.62%, = 0.001) and length of hospital stay in the ICU (7 days to 5 days, = 0.005) were lower in the post-antimicrobial stewardship program implementation group.
Pharmacist-led education and prospective audit and feedback on antibiotic dose optimization can improve appropriate antibiotic dosing and therapeutic drug monitoring with a high acceptance rate. We suggest implementing this strategy in other intensive care units such as surgical intensive care units. We still found some nonadherence to our dosing guidelines; additional strategies to optimize dosing should be evaluated.
危重病会影响抗菌药物的药代动力学和药效学。抗菌药物管理计划可促进抗菌药物的合理使用。本研究旨在比较在医疗重症监护病房实施抗菌药物管理计划前后抗生素给药的合理性、治疗药物监测情况及重症监护病房死亡率。
本回顾性研究在泰国朱拉隆功国王纪念医院进行。纳入2019年8月1日至2021年7月31日期间入住医疗重症监护病房且在抗菌药物管理计划中接受选定抗生素治疗的成年人。在干预期间，由传染病药剂师和临床药剂师实施了一般教育以及带有干预和反馈的前瞻性审核。比较了抗菌药物管理计划实施前后给药的合理性、治疗药物监测情况及重症监护病房死亡率。
抗菌药物管理计划实施前组有269例患者（455张处方），实施后组有376例患者（604张处方）。美罗培南是两组中最常开具的抗生素。总体而言，抗菌药物管理计划实施后给药的合理性和治疗药物监测情况有所改善（从36%提高到63.58%，P<0.001）。传染病和临床药剂师提供了40次干预，接受率为87.5%。最常见的建议是调整维持剂量（接受率为79.17%）。抗菌药物管理计划实施后组的重症监护病房死亡率（从29.37%降至18.62%，P=0.001）和在重症监护病房的住院时间（从7天降至5天，P=0.005）较低。
由药剂师主导的教育以及对抗生素剂量优化的前瞻性审核和反馈可以提高抗生素给药的合理性和治疗药物监测情况，且接受率较高。我们建议在其他重症监护病房如外科重症监护病房实施这一策略。我们仍发现一些未遵守我们给药指南的情况；应评估优化给药的其他策略。
