Potential Impact of the Involvement of Clinical Pharmacists in Antimicrobial Stewardship Programs on the Incidence of Antimicrobial-Related Adverse Events in Hospitalized Patients: A Multicenter Retrospective Study

Abstract

Although specialized pharmacists have been suggested to be essential members of antimicrobial stewardship programs (ASPs), not all hospitals in Korea operate ASPs with pharmacists involved. We aimed to evaluate the association of involvement of clinical pharmacists as team members of multidisciplinary ASPs with the incidence of antimicrobial-related adverse drug events (ADEs). Five tertiary teaching hospitals participated in this retrospective cohort study. At each participating hospital, we randomly selected 1000 participants among patients who had received systemic antimicrobial agents for more than one day during the first quarter of 2017. We investigated five categories of antimicrobial-related ADEs: allergic reactions, hematologic toxicity, nephrotoxicity, hepatotoxicity, and antimicrobial-related diarrhea. Multivariate logistic regression analysis was used to evaluate the potential impact of pharmacist involvement in ASPs on the incidence of ADEs. A total of 1195 antimicrobial-related ADEs occurred in 618 (12.4%) of the 4995 patients included in the analysis. The overall rate of ADE occurrence was 17.4 per 1000 patient days. Hospitals operating ASPs with pharmacists showed significantly lower AE incidence proportions than other hospitals (8.9% vs. 14.7%; p < 0.001). Multidisciplinary ASPs that included clinical pharmacists reduced the risk of antimicrobial-related ADEs by 38% (adjusted odds ratio 0.62; 95% confidence interval 0.50–0.77). Our results suggest that the active involvement of clinical pharmacists in multidisciplinary ASPs may contribute to reduce the incidence of antimicrobial-related ADEs in hospitalized patients.

The role of the clinical pharmacist in antimicrobial stewardship in Asia: A review

“…38 Another retrospective study in South Korea reported that an ASP with clinical pharmacist involvement was associated with a decrease in the incidence of antimicrobialrelated adverse events (8.9% vs 14.7%; P < .001). 39 Finally, similar to previous studies, a study on clinical pharmacist involvement in the ASP in India showed an increase in the proportion of appropriate prescriptions during the third year of the intervention period. 40 Similar to those reported in Western developed countries like the United States, the acceptance rates of clinical pharmacist recommendations in Asia range from 70% to 94%.…”

The implementation of antimicrobial stewardship in Indonesia: a regional survey in hospitals

“…A multidisciplinary antimicrobial stewardship approach, active involvement of a drug and therapy committee or equivalent, formulary limitations, and the availability of antimicrobial stewardship education and training for pharmacists and physicians are essential components for an antimicrobial stewardship program to be considered successful in Makkah region hospitals [26]. The potential for pharmacist involvement in Antimicrobial stewardship program in the incidence of Adverse drug events shows a much lower proportion of Adverse events than in other hospitals that do not involve a pharmacist.These results suggest that the active involvement of pharmacists in multidisciplinary Antimicrobial stewardship program contributes to reducing the incidence of antimicrobial adverse drug events in hospitalized patients [27]. Pharmacist-led ASP was associated with a reduction in the number of days of antimicrobial therapy for uncomplicated gram-negative bacteremia among patients admitted to a community hospital without an infectious disease specialist.…”

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

“…In Korea, a multicenter study was conducted in five general hospitals to investigate the incidence of adverse reactions to antimicrobial agents. Hospitals that implemented multidisciplinary ASPs that included pharmacists had a lower incidence of adverse reactions to antimicrobial agents than those with ASPs without pharmacists (8.9% vs. 14.7%, P <0.001), and ASPs managed by a multidisciplinary teams that included pharmacists had a 38% lower incidence of adverse reactions to antimicrobial agents (OR: 0.62) [ 170 ].…”