İlerler Enes Emir, Ayhan Yunus Emre, Yalçinkaya Erdem, Karakurt Sait, Sancar Mesut
Department of Clinical Pharmacy, Marmara University, Istanbul, Türkiye.
Department of Clinical Pharmacy, Cemil Taşcıoğlu City Hospital, Istanbul, Türkiye.
Front Pharmacol. 2025 May 26;16:1556884. doi: 10.3389/fphar.2025.1556884. eCollection 2025.
Antimicrobial use in ICUs is challenging due to altered pharmacokinetics, severe infections, and the burden of comorbidities. This study aims to investigate the contribution of clinical pharmacy services in reducing antimicrobial drug therapy problems (ADTPs) in the intensive care unit.
This study was a prospective, pre-post intervention study conducted over a total duration of 6 months (15 January 2023-15 July 2023) in Türkiye. During both control period (CP) and intervention period (IP), ADTPs were identified and classified according to established definitions describing each day of therapy with a specific antimicrobial agent. In IP, clinical pharmacist-led services were implemented for the ICU team, encompassing problem-targeted educational sessions and bedside intervention recommendations.
A total of 85 patients (CP, n = 43; IP, n = 42) were included in the study. The mean age of the patients was 68.87 years (SD = 16.09). The most common indication for antimicrobial initiation was pneumonia (56.5%), while the most frequently used antimicrobial agent throughout the study was piperacillin-tazobactam (44.7%). It was found that 5.5% of patients across all periods received unnecessary, 2.2% inappropriate, and 92.3% sub-optimal antimicrobial therapy. During both CP and IP, almost all ATDPs were categorized under sub-optimal treatment problems related to medication dosage and/or administration regimens (93.94% vs. 88%). A statistically significant 62% reduction in total ADTPs was observed during IP compared to CP (total ADTPs, 66 vs. 25; p = 0.001).
This study identified a high incidence of ADTPs in the ICU, with the majority classified as sub-optimal. The significant reduction in ADTPs observed between the periods with the provision of clinical pharmacy services highlights the effective role of clinical pharmacists in reducing ADTPs.
由于药代动力学改变、严重感染和合并症负担，重症监护病房（ICU）的抗菌药物使用具有挑战性。本研究旨在调查临床药学服务在减少重症监护病房抗菌药物治疗问题（ADTPs）方面的作用。
本研究是一项前瞻性的干预前后研究，在土耳其进行，总时长为6个月（2023年1月15日至2023年7月15日）。在对照期（CP）和干预期（IP），根据既定定义对ADTPs进行识别和分类，这些定义描述了使用特定抗菌药物治疗的每一天。在IP期，为ICU团队实施了由临床药师主导的服务，包括针对问题的教育课程和床边干预建议。
本研究共纳入85例患者（CP期，n = 43；IP期，n = 42）。患者的平均年龄为68.87岁（标准差 = 16.09）。启动抗菌治疗最常见的指征是肺炎（56.5%），而在整个研究中最常用的抗菌药物是哌拉西林 - 他唑巴坦（44.7%）。发现在所有时期，5.5%的患者接受了不必要的抗菌治疗，2.2%的患者接受了不恰当的抗菌治疗，92.3%的患者接受了次优的抗菌治疗。在CP期和IP期，几乎所有的ADTPs都归类于与药物剂量和/或给药方案相关的次优治疗问题（93.94%对88%）。与CP期相比，IP期观察到ADTPs总数有统计学意义的62%的下降（ADTPs总数，66对25；p = 0.001）。
本研究发现ICU中ADTPs的发生率很高，大多数归类为次优。在提供临床药学服务的时期之间观察到的ADTPs显著减少，突出了临床药师在减少ADTPs方面的有效作用。
