Optimizing Prophylactic Antibiotic Practice for Cardiothoracic Surgery by Pharmacists’ Effects

Abstract

Pharmacists’ role may be ideal for improving rationality of drug prescribing practice. We aimed to study the impact of multifaceted pharmacist interventions on antibiotic prophylaxis in patients undergoing clean or clean-contaminated operations in cardiothoracic department.A pre-test–post-test quasiexperimental study was conducted in a cardiothoracic ward at a tertiary teaching hospital in Suzhou, China. Patients admitted to the ward were collected as baseline group (2011.7–2012.12) and intervention group (2013.7–2014.12), respectively. The criteria of prophylaxis antibiotic utilization were established on the basis of the published guidelines and official documents. During the intervention phase, a dedicated pharmacist was assigned and multifaceted interventions were implemented in the ward. Then we compared the differences in antibiotic utilization, bacterial resistance, clinical and economic outcomes between the 2 groups. Furthermore, patients were collected after the intervention (2015.1–2015.6) to evaluate the sustained effects of pharmacist interventions.412 and 551 patients were included in the baseline and intervention groups, while 156 patients in postintervention group, respectively. Compared with baseline group, a significant increase was found in the proportion of antibiotic prophylaxis, the proportion of rational antibiotic selection, the proportion of suitable prophylactic antibiotic duration, and the proportion of suitable timing of administration of the first preoperative dose (P < 0.001). Meanwhile, a significant reduction was seen in the rate of unnecessary replacement of antibiotics and the rate of unnecessary combinations (P < 0.001). Besides, pharmacist intervention resulted in favorable outcomes with significantly decreased rates of surgical site infections, prophylactic antibiotic cost, and significantly shortened length of stay (P < 0.05). Furthermore, there were also significant decreases of the rates of antibiotic resistant enterobacter cloacae, klebsiella pneumonia, and staphylococcus aureus (P < 0.05). Moreover, the effects were sustained after discontinuation of the active interventions, as shown in prophylactic antibiotic utilization data.Pharmacist interventions in cardiothoracic surgery result in a high adherence to evidence-based treatment guidelines and a profound culture change in drug prescribing with favorable outcomes. The effects of pharmacist intervention are sustained and the role of pharmacists is emphasized for rational medication and optimal outcomes in clinical treatment.

Avaliação da profilaxia antimicrobiana cirúrgica em um hospital de ensino

“…21 Resultado de estudo de intervenção que utilizou como estratégias a realização de rodas de conversa com as equipes, distribuição de material educativo e retorno sobre desempenho individual para os prescritores apontam o aumento da adequação no uso da profilaxia antimicrobiana de 42,10% para 97,10% após a intervenção. 19 A maior parte do uso da profilaxia antimicrobiana não cumpre as diretrizes dos guidelines. Esses recomendam que a administração da profilaxia antimicrobiana não seja realizada nos casos de cirurgia limpa, sem prótese, eletivas e em pacientes de baixo risco.…”

“…Sugere-se que sejam realizadas intervenções multifacetadas com o intuito de adequar os processos de trabalho das equipes que laboram no centro cirúrgico aos protocolos baseados em evidências. 13,14,[16][17][18][19] No que diz respeito à avaliação da duração da profilaxia, observou-se que em 94,3% dos procedimentos a administração foi descontinuada em até 48 horas, conforme preconizado pelo protocolo institucional. Achado também evidenciado em estudos realizados na China, Malásia e Kuwaite de grande relevância já que o prolongamento da profilaxia antimicrobiana após a cirurgia aumenta o risco de resistência bacteriana, de reação à droga, de incidência de infecção e colonização por microrganismos resistentes, além de elevar os custos.…”

“…Achado também evidenciado em estudos realizados na China, Malásia e Kuwaite de grande relevância já que o prolongamento da profilaxia antimicrobiana após a cirurgia aumenta o risco de resistência bacteriana, de reação à droga, de incidência de infecção e colonização por microrganismos resistentes, além de elevar os custos. 14,16,[19][20] Com relação à administração de dose adicional do antibiótico (repique) nos procedimentos que ultrapassaram duas vezes o tempo de meia vida da droga de escolha, observou-se a não administração em 77,80% dos casos. Realidade preocupante, que contraria as recomendações baseadas em evidências e distinta das demonstradas em estudos realizados no sudeste brasileiro e sudeste asiá-…”

Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

“…In this study, pharmacists fulfilled a vital function as key members in facilitating TXA therapy for TKA patients. To date, the roles of pharmacist intervention have been addressed in patients with Crohn's disease and ulcerative colitis, chronic obstructive pulmonary disorder, antibiotic treatment and other conditions. This present study is the first to incorporate pharmacist clinical interventions in blood conservation treatment for TKA patients, and it found favourable clinical and economic outcome.…”

Quality of Perioperative Antibiotic Prophylaxis in a Community Hospital in Western Qatar

“…Published reports describe a variable compliance with guidelines and the effectiveness of an intervention for its improvement [4][5][6][7][8][9].…”