The impact of pharmacist-led antimicrobial stewardship program on antibiotic use in a county-level tertiary general hospital in China: A retrospective study using difference-in-differences design

Abstract

BackgroundInappropriate use of antibiotics has become a major driver for the spread of antimicrobial resistance globally, particularly common in China. Antimicrobial stewardship programs are effective in optimizing antimicrobial use and decreasing the emergence of multi-drug-resistant organisms, and the pharmacist has performed a leading role in this program.ObjectiveTo evaluate the impact of antimicrobial stewardship programs driven by pharmacists on antibiotic consumption and costs and the appropriateness of antibiotic use.MethodsA single-center retrospective quasi-experimental design was conducted in two independent hepatobiliary surgery wards and two independent respiratory wards in a county-level tertiary general hospital in Jiangsu, China. Each intervention group was served with antimicrobial stewardship programs with prescriptions audit and feedback, antibiotics restriction, education, and training. The propensity score matching method was employed to balance confounding variables between the intervention group and control group, and a difference-in-differences analysis was used to evaluate the impact of antimicrobial stewardship programs. The primary outcome was measured by scores of rationality evaluation of antibiotics.ResultsThe DID results demonstrated that the implementation of the antimicrobial stewardship programs was associated with a reduction in the average length of hospital stay (coefficient = −3.234, p = 0.006), DDDs per patient (coefficient = −2.352, p = 0.047), and hospitalization costs (coefficient = −7745.818, p = 0.005) in the hepatobiliary surgery ward, while it was associated with a decrease in DDDs per patient (coefficient = −3.948, p = 0.029), defined daily doses per patient day (coefficient = −0.215, p = 0.048), and antibiotic costs (coefficient = −935.087, p = 0.014) in the respiratory ward. The program was also associated with a decrease in rationality evaluation scores (p < 0.001) in two wards.ConclusionThe result reveals that the implementation of the antimicrobial stewardship programs is effective in reducing the length of hospital stay, decreasing antibiotics consumption and costs, and improving the appropriateness of antimicrobial use such as decreasing irrational use of cephalosporins, reducing combinations, and improving timely conversion. However, great attention ought to be paid to the improper use of broad-spectrum antibiotics. The government is responsible for providing sustainable formal education for pharmacists, and more funding and staff support to promote antimicrobial stewardship programs.

The participation of clinical pharmacists in the treatment of patients with central nervous system infection can improve the effectiveness and appropriateness of anti-infective treatments: a retrospective cohort study

“…Pharmacists participate in antimicrobial stewardship, infection prevention and control efforts through clinical efforts focused on the appropriate use of antimicrobial agents and through membership in relevant multidisciplinary workgroups and committees within the healthcare system ( Saseen et al, 2017 ; Lai et al, 2022 ). Currently, pharmacists in China mainly participate in the daily ward rounds in neurosurgery units and review medication regimens ( Zhang et al, 2020b ; Zhang et al, 2021 ; Wang et al, 2022 ; Gu et al, 2023 ). The involvement of pharmacists in patient medical treatment and monitoring is the ideal approach in neurosurgery units because of the complexity of CNSI, the severity of these diseases, and the difficulty of drug selection.…”

Effectiveness Analysis of Clinical Pharmacists-Led Medication Therapy of Refined Management Mode:Antibiotics Administration

“…They play an important role in the development of antibiotics treatment plans according to the PK/PD theory of antimicrobial drugs [18].Other factors needed to be considered include the severity of the patient's condition, site of infection, tissue penetration, antimicrobial drug selection, clinical e cacy, safety, possible pathogenic bacteria, assessment of antimicrobial resistance, protein binding rate, and liver and kidney function. Clinical pharmacist intervention can reduce the rate of unreasonable drug application [19,20,21], shorten the length of hospital stay of patients, lower the incidence of adverse drug reactions, and improve the effect of anti-infection treatment. Daijing Dong et al [22] found the rational rate of prophylactic use of antibiotics in class I incisions was signi cantly improved, and the course of medication was obviously reduced before and after the intervention of clinical pharmacists.Meanwhile, other studies also pointed out [23,24] that the participation of clinical pharmacists in the consultation and individualized adjustment of medication regimens can ensure that patients receive more economic and effective treatment, and have a positive impact on reducing the inhospital mortality of patients with multi-drug resistant infection.…”

Tailored pharmacist-led intervention to improve adherence to Iron supplementation in premature infants: a randomized controlled trial in China

“…Many pharmacists in China have been released from conventional dispensing as part of the reform of medical policy. One method for changing medication-related perceptions and increasing the adherence to iron supplements treatment among parents of preterm infants is pharmacist-led education and counseling ( 17 , 18 ).…”