The Effectiveness of Clinical Pharmacist-Led Consultation in the Treatment of Infectious Diseases: A Prospective, Multicenter, Cohort Study

Abstract

Background: Antimicrobial resistance (AMR) is a serious global health threat and leads to a huge challenge to infectious diseases (ID) treatment. To tackle AMR, regional 'Antimicrobial Stewardship Programs' (ASP) have been implemented in many countries. Due to insufficient clinical pharmacy resources, a major intervention mode of ASP in China is through clinical pharmacist-led consultation (CPC). The current study aims to prospectively evaluate this intervention and compare the effectiveness of CPC served by ID and non-ID clinical pharmacists. Methods: We conducted a prospective and multicenter cohort study based on a regional registry database in 17 hospitals in Western China, including consecutive patients with ID between April 2017 and December 2019. Baseline characteristics including sex, age, liver and kidney function, comorbidity, infection severity were prospectively collected and recorded. The main exposure of interest was whether the attending physician adopted recommendations of the clinical pharmacist in the therapeutic scheme. The outcome was the infection effective response, assessed during day 3-7 after completing CPC. Multivariate analyses were performed by generalized linear mixed models. Results: A total of 2,663 ID patients were included in the final analysis according to the predesigned inclusion and exclusion criteria. The number of patients whose treatment followed

Antibiotics and the Nervous System—Which Face of Antibiotic Therapy Is Real, Dr. Jekyll (Neurotoxicity) or Mr. Hyde (Neuroprotection)?

“…Clinical pharmacist intervention has been shown to be effective in enhancing appropriate use of antibiotics and reducing their toxicity, which may improve patient care. Moreover these had a positive impact not only on the clinical, but on financial outcomes [131][132][133][134][135].…”

Hypoalbuminemia as Surrogate and Culprit of Infections

“…Similarly, in 222 adult patients hospitalized with Staphylococcus aureus bacteremia, treatment failure at 30 days was independently associated with serum albumin levels (adjusted odds ratio, 0.88; 95% confidence interval, 0.80 to 0.96; p = 0.003) [ 180 ]. A recent prospective cohort study of clinical pharmacist-led antimicrobial treatment consultation in 2663 patients confirmed that hypoalbuminemia is independently associated with a decrease in effective response rate to antimicrobial treatment (adjusted odds ratio, 0.69; 95% confidence interval, 0.52 to 0.92; p = 0.012) [ 186 ].…”

Integrating Multidisciplinary Individualized Medication Recommendations Into the Traditional Pharmacists’ Consultation Method: A Retrospective Study Using Propensity Score Matching Analysis

“…In terms of this primary endpoint, we would have addressed ERC as the minimal response rate (MRR). However, when searching for relevant literature, we found that in the studies of Zhang JX et al 5,56 on the effectiveness of clinical pharmacists’ consultations, the primary endpoint was effective response (complete or partial response). The endpoint was defined as partial or complete resolution of clinically significant signs/symptom improvement or resolution of computed tomography (CT) or magnetic resonance imaging (MRI) findings and on proven or negative culture results.…”