Impact of an Antimicrobial Stewardship Program Introduced by Pharmacist

Sasaki, Yasuhiro; Kanamaru, Ayumi; Yamakuchi, Akiko; Yano, Masataka

doi:10.4058/jsei.32.369

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Cases of improved patient outcomes through AS activities have also been reported at other institutions 7–12 . On the other hand, many of the registered members of AST teams all over Japan who are active full‐time are nurses, and it has become clear that these nurses are compatible with Infection Control Team work, and labour shortages have become a problem 13 .…”

Section: Discussionmentioning

confidence: 94%

“…Cases of improved patient outcomes through AS activities have also been reported at other institutions. [7][8][9][10][11][12] On the other hand, many of the registered members of AST teams all over Japan who are active full-time are nurses, and it has become clear that these nurses are compatible with Infection Control Team work, and labour shortages have become a problem. 13 It is an activity in the same situation at our hospital, and it is an advantage that we were able to achieve more efficient work, and it is an original system.…”

Section: Discussionmentioning

confidence: 99%

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Improving patient outcomes by promoting antimicrobial stewardship for patients with positive blood cultures: Investigation of patients with gram negative bacterium

Tai

Yamaguchi

Watanabe

et al. 2022

Clinical Pharmacy Therapeu

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What Is Known and Objective In this study, changes in patient outcomes were analysed to evaluate the effects of prospective audit and feedback (PAF), which was promoted under a new system of antimicrobial stewardship (AS), in patients with gram‐negative rod (GNR)‐positive blood cultures. Methods This study included patients with positive blood cultures treated at Kagawa University Hospital between 2019 and 2020. The effects of PAF, as promoted in 2020 and performed within a few days of treatment initiation, were examined in terms of patient prognosis and estimated cost of extra hospital stay associated with GNR infection. Results and Discussion As AS activities under the new system, proposals were made for targeted therapy based on susceptibility results and for the duration of antimicrobial therapy, escalation and dose increases, and imaging evaluation. Between 2019 and 2020, there was no difference in the rate of de‐escalation in the form of switching to a narrower‐spectrum intravenous antimicrobial, the rate of image inspection, but the rate of switching to oral therapy after receiving culture results increased from 19.7% to 31.3%, the rate of sensitivity‐based treatment increased from 76.4% to 92.2%. Regarding patient outcomes, the 90‐day mortality rate and the duration of hospital stay were similar between the groups. The rate of recurrent bloodstream infections decreased from 8.7% to 0.9%. What Is New and Conclusion Most of the changes in the indicators related to patient outcomes analysed in this study suggest that the increased use of PAF in AS activities improved patient outcomes.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Improving patient outcomes by promoting antimicrobial stewardship for patients with positive blood cultures: Investigation of patients with gram negative bacterium

Tai

Yamaguchi

Watanabe

et al. 2022

Clinical Pharmacy Therapeu

View full text Add to dashboard Cite

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Evaluation after implementation of chemical bowel preparation for surgical site infections in elective colorectal cancer surgery and role of antimicrobial stewardship pharmacist: Retrospective cohort study

Sasaki,

Kurishima,

Miyamoto

et al. 2024

J Pharm Health Care Sci

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Background We evaluated the predictive factors for surgical site infections (SSIs) in elective colorectal cancer surgery and the role of antimicrobial stewardship (AS) pharmacists in modifying the clinical pathway. Main body Between February 2017 and January 2022, 414 elective colorectal cancer surgeries were performed. The results of multivariate analysis by SSI incidence were adjusted odds ratio (aOR): 0.45; 95% confidence interval (CI): 0.22–0.96 (P = 0.039) for sex (female), aOR: 0.27; 95% CI: 0.13–0.58 (P < 0.001) for laparoscopy, aOR: 0.42; 95% CI: 0.19–0.91 (P = 0.029) for chemical bowel preparation. The median (interquartile range) postoperative length of stay was 12 (10.0–18.5) vs. 10 (9.0–13.0) days before and after the clinical pathway was modified (P < 0.001). Conclusion The role of AS pharmacists was primarily to conduct a literature search to explore whether SSIs could be ameliorated by pharmacotherapy, coordinate the addition of chemical bowel preparation, and epidemiologically confirm their effectiveness.

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Effect of De-escalation Facilitated by Antimicrobial Stewardship Activities on Blood Culture Positive Patient Outcomes

Tai

Yamaguchi

Watanabe

et al. 2020

Jpn. J. Pharm. Health Care Sci.

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To evaluate changes in the ef cacy and safety of antimicrobial therapy through de-escalation improved by the antimicrobial stewardship (AS) activities, which started from 2013 in Kagawa University Hospital, we analyzed changes in the de-escalation rate and the patient outcomes. The number of carbapenem-treated cases evaluated as improper use had decreased from 2013 to 2017. In most of these cases, improper use of blood culture was indicated. The AS team directed the proper use of carbapenem through weekly rounds, focusing on intervention and feedback according to the guideline. This activity was performed with emphasis on the appropriate use of blood culture results and the process of target therapy. As a result, it was shown that the number of blood culture orders and the rates of hospitalized cases, for which multiple sets of blood cultures were ordered, were increased. Also, the de-escalation rate of blood culture-positive cases treated with carbapenem was improved from 13.1 in 2011 to 29.9 in 2017. Furthermore, as a patient outcome, the 90-day mortality rate was decreased from 24.3 in 2011 to 15.6 in 2017. Similarly, the recurrent bloodstream infections rate was decreased from 5.6 to 0 . On the other hand, in 2011 vs 2017, there was no signi cant difference in the detection rate of resistant bacteria. Taken together, most of the changes in the indicators related to patient outcome analyzed in the present study suggest that AS activities improved the de-escalation rate, and that the de-escalation contributed to the ef cacy and safety of antimicrobial therapy.

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Impact of an Antimicrobial Stewardship Program Introduced by Pharmacist

Cited by 3 publications

References 8 publications

Improving patient outcomes by promoting antimicrobial stewardship for patients with positive blood cultures: Investigation of patients with gram negative bacterium

Improving patient outcomes by promoting antimicrobial stewardship for patients with positive blood cultures: Investigation of patients with gram negative bacterium

Evaluation after implementation of chemical bowel preparation for surgical site infections in elective colorectal cancer surgery and role of antimicrobial stewardship pharmacist: Retrospective cohort study

Effect of De-escalation Facilitated by Antimicrobial Stewardship Activities on Blood Culture Positive Patient Outcomes

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