Pharmacist-led antimicrobial stewardship programme in a small hospital without infectious diseases physicians

Abstract

Pharmacists may be tasked to lead antibiotic stewardship programmes (ASP) implementation in small hospitals in absence of infectious diseases (ID) physicians. The objectives are to evaluate the effectiveness of a pharmacist-led ASP in a hospital without ID physician support, with special focus on indicators of the hospital use of antimicrobial agents based on consumption and asess the potential clinical and economic impact of pharmacist interventions (PIs) through the CLEO tool. A prospective quasi-experimental study to implement an ASP in a 194-bed hospital. We evaluated changes in antimicrobial use measured as mean defined daily doses per 1000 patient-days (AUD) for intervention versus preintervention period. A total of 847 antimicrobial PIs were proposed, being 88.3% accepted. Discontinuation due to excessive duration was the most frequently performed PI (23.4%). Most of PIs was classified as major or moderate clinical impact, 41.7% and 37.8% respectively. The global consumption of antimicrobial was reduced from 907.1 to 693.8 AUD, with a signifcant drop in carbapenems and quinolones. Direct expenditure of antibiotics decreased significantly. Pharmacist-led ASP has being effective in reducing consumption of antibiotics. In the absence of ID physician´s support and oversight, pharmacists could lead the improvement of the use of antimicrobials.

Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection

“…This evidence suggests that the quality of BSI treatment can be improved by pharmacist-driven PAF, regardless of the bacterial species. It has been noted that the human resources of ID physicians are limited, and the implementation of ASPs by ID physicians universally is difficult [ 22 ]. Meanwhile, pharmacists, who have more human resources devoted to ASPs [ 23 ], are expected to be leaders in promoting ASPs.…”

The Role of Clinical Pharmacists in Antimicrobial Stewardship Programs (ASPs): A Systematic Review

“…High acceptance rates of pharmacist recommendations by physicians were observed, demonstrating the credibility of pharmacists in ASPs [ 25 , 29 ]. Pharmacist stewardship significantly reduced overall antibiotic use, associated costs, and excessive therapy duration across various hospital departments, leading to substantive cost savings [ 20 , 28 ].…”

“…Heyerly et al [12] Reduced time to optimal antibiotics, more patients reached optimal therapy in ≤2 hours Rapid testing + pharmacist intervention improved the time to optimal antibiotics over rapid testing alone De-escalation programs led by pharmacists safely reduced the duration of antibiotic therapy and length of hospital stay without negatively impacting outcomes for gram-negative bacteremia [23], urinary tract infection [21], and other infections. Pharmacist antimicrobial stewardship (AMS) interventions reduced overall antibiotic use, costs, and therapy duration across various hospital settings, including general medicine wards [20], emergency departments [18], radiology departments [29], and small hospitals without infectious disease specialists [28]. Several studies found high acceptance rates of physician/pharmacist recommendations (Table 2) [25,29].…”

Antimicrobial resistance control activities at a tertiary hospital in a low-resource setting: an example of Queen Elizabeth Central Hospital in Malawi

“…Engagement of the hospital pharmacy including an understanding of antibiotic availability and consumption is essential in developing robust antimicrobial prescribing practices in the context of high AMR rates in hospital settings. Some (small) hospitals have demonstrated that, in settings where there are no infectious diseases physicians or microbiologists, pharmacist-led AMS programmes can be effective in reducing the consumption of antimicrobials and therefore retard the development of AMR (Cantudo-Cuenca et al, 2022).…”