Overuse of empirical antibiotics in a COVID-19 intensive care unit led to the spread of carbapenem-resistant Gram-negative bacteria in a teaching hospital

Dambroso-Altafini, Daniela; Saalfeld, Silvia Maria dos Santos; Mattos, Monica de Souza Ferreira de; Martinez, Hilton Vizzi; Shinohara, Danielle Rosani; Zarpellon, Mirian Nicéa; Costa, Bruno Buranello; Tognim, Maria Cristina Bronharo

doi:10.1016/j.jgar.2022.06.006

Cited by 4 publications

(1 citation statement)

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“…Our results indicate that while the pharmacist intervention did not decrease the rate or duration of antibiotic use, it effectively reduced the use of special-grade antibiotics. These antibiotics, reserved for use by specially qualified physicians in China, play a significant role in combating antimicrobial resistance ( Mancuso, 2021 ; Dambroso-Altafini, 2022 ). Despite this, overuse of antibiotics in the ICU remains a significant issue, with empirical therapy often not adequately adjusted even in confirmed cases of sepsis ( Timsit, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of pharmaceutical care in adult critically ill patients: based on a prospective cohort study

Wei,

Hu,

Chen

et al. 2024

Front. Pharmacol.

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BackgroundThe medication regimen for critically ill patients is complex and dynamic, leading to a high incidence of drug-related problems. This study aimed to assess the effectiveness and economic efficiency of pharmaceutical care for these patients.MethodsIn this prospective cohort study conducted in a tertiary hospital, adult patients were assigned either to a clinical pharmaceutical care group or a control group based on existing clinical grouping rules. Health outcomes and economic indicators were collected, followed by a cost-effectiveness analysis.ResultsThe acceptance rate for clinical pharmacist interventions was 89.31%. The pharmaceutical care group exhibited significant reductions in the rate of medication errors (40.65% vs. 61.69%, P < 0.001) and adverse drug events (44.52% vs. 56.45%, P = 0.020). The usage rates for special-grade antibiotics (85.16% vs. 91.13%, P = 0.009) and proton pump inhibitors (77.42% vs. 88.71%, P = 0.002) were also lower in the pharmaceutical care group. Secondary outcomes did not show significant differences in total hospital stay (21 days vs. 22 days, P = 0.092). However, ICU stay was significantly shorter (9 days vs. 11 days, P = 0.003) in the pharmaceutical care group. Cost-effectiveness analysis demonstrated that each 1% reduction in adverse drug events associated with ICU pharmaceutical care saved $226.75 in ICU hospitalization costs and $203.42 in total ICU drug costs. A 1% reduction in the medication error rate saved $128.57 in ICU hospitalization costs and $115.34 in total ICU drug costs.ConclusionsPharmaceutical care significantly reduces adverse drug events and medication errors, promotes rational use of medications, decreases the length of ICU stay, and lowers treatment costs in critically ill patients, establishing a definitive advantage in terms of cost-effectiveness.

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Section: Discussionmentioning

confidence: 99%