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Dighriri IM, Alnomci BA, Aljahdali MM, Althagafi HS, Almatrafi RM, Altwairqi WG, Almagati AA, Shunaymir AM, Haidarah GA, Alanzi MH, Hadadi AA, Suwaydi HM, Aqdi MJ, Alharthi HN, Alshahrani AF. The Role of Clinical Pharmacists in Antimicrobial Stewardship Programs (ASPs): A Systematic Review. Cureus 2023; 15:e50151. [PMID: 38186441 PMCID: PMC10771624 DOI: 10.7759/cureus.50151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Antimicrobial resistance (AMR) is a major global health threat, increasing deaths and healthcare costs. Antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use and curb resistance. This systematic review aimed to summarize evidence on the role and impact of pharmacists in hospital ASPs. A comprehensive literature search was conducted across databases to identify relevant studies published from 2016 to 2023. Twenty-four studies met the inclusion criteria, comprising global observational and randomized clinical trials. Pharmacists performed various stewardship activities, including prospective audits, formulary management, de-escalation, guideline development, and education. Pharmacist-led interventions significantly improved antibiotic prescribing, reduced unnecessary antibiotic use, optimized therapy, and enhanced outcomes. Multiple studies found that pharmacist reviews decreased the time to optimal antibiotics and improved guideline compliance without affecting readmissions or revisits. De-escalation programs safely reduced antibiotic duration and length of stay. Acceptance rates for recommendations were high. Pharmacist stewardship curbed overall antibiotic use, costs, and duration across hospital departments, leading to savings. While most studies showed positive impacts, fewer detected significant changes in resistance or mortality over short periods. More research is needed, but current evidence demonstrates that pharmacists play critical roles in ASPs, leading to improved antibiotic use and patient outcomes. These findings support integrating pharmacists into stewardship activities, significantly extending programs to ambulatory settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mohmmad H Alanzi
- Department of Emergency Pharmacy, Dr. Sulaiman Al Habib Hospital, Riyadh, SAU
| | | | | | - Maha J Aqdi
- Faculty of Pharmacy, Jazan University, Jazan, SAU
| | - Hamed N Alharthi
- Department of Forensic Center, Forensic Medical Services Center, Al Baha, SAU
| | - Amaal F Alshahrani
- Department of Pharmacy, Armed Forces Hospital Southern Region, Abha, SAU
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2
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Bao H, Dubrovskaya Y, Jen SP, Decano A, Ahmed N, Pham VP, Papadopoulos J, Siegfried J. Novel Multidisciplinary Approach for Outpatient Antimicrobial Stewardship Using an Emergency Department Follow-Up Program. J Pharm Pract 2021; 36:329-335. [PMID: 34592864 DOI: 10.1177/08971900211048311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Outpatient antimicrobial stewardship programs (ASPs) are becoming increasingly prevalent in healthcare. Many programs have demonstrated the effectiveness of pharmacist-driven outpatient consultations or follow-up programs to ensure appropriate antimicrobial prescribing. However, there is a paucity of literature describing multidisciplinary approaches in large healthcare systems for patients discharged from the emergency department (ED). The objective of this study was to describe the feasibility and impact of a combined effort between ASP pharmacotherapy specialists and nurse practitioners (NPs) in managing an ED follow-up center. Methods: A retrospective analysis was conducted for patients discharged from the ED between January 2018 and June 2019. Patients were identified for inclusion based on documentation by ASP pharmacotherapy specialists in the electronic health record for patient-specific inquiries from ED follow-up center NPs. The primary outcome of this study was to describe the number and types of interventions made by ASP pharmacotherapy specialists. Results: A total of 1088 patients were included in the study, for 1114 documented ASP calls. The urinary tract was the most common source of positive culture (79%), and third-generation cephalosporins were the most frequent antibiotic associated with calls (20%). Out of total calls, 60% lead to ASP interventions. Among total calls, the most frequent interventions were to correct drug-bug mismatches (20%), initiate new therapy (10%), and discontinue therapy (7%). Conclusion: This report describes a novel initiative that combines the efforts of ED NPs and ASP pharmacotherapy specialists in managing an ED follow-up center at a large healthcare system.
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Affiliation(s)
- Hongkai Bao
- Department of Pharmacy, Montefiore Medical Center, the Bronx, NY, USA
| | - Yanina Dubrovskaya
- Department of Pharmacy, 12297NYU Langone Health, New York, NY, USA.,Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Shin-Pung Jen
- Department of Pharmacy, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Arnold Decano
- Department of Pharmacy, NYU Langone Hospital Brooklyn, Brooklyn, NY, USA
| | - Nabeela Ahmed
- Department of Pharmacy, NYU Langone Hospital Brooklyn, Brooklyn, NY, USA
| | - Vinh P Pham
- Department of Medicine, New York University School of Medicine, New York, NY, USA.,Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - John Papadopoulos
- Department of Pharmacy, 12297NYU Langone Health, New York, NY, USA.,Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Justin Siegfried
- Department of Pharmacy, 12297NYU Langone Health, New York, NY, USA
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Lubin IM. Bringing the clinical laboratory into the strategy to advance diagnostic excellence. Diagnosis (Berl) 2021; 8:281-294. [PMID: 33554526 PMCID: PMC8255320 DOI: 10.1515/dx-2020-0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/16/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Clinical laboratory testing provides essential data for making medical diagnoses. Generating accurate and timely test results clearly communicated to the treating clinician, and ultimately the patient, is a critical component that supports diagnostic excellence. On the other hand, failure to achieve this can lead to diagnostic errors that manifest in missed, delayed and wrong diagnoses. CONTENT Innovations that support diagnostic excellence address: 1) test utilization, 2) leveraging clinical and laboratory data, 3) promoting the use of credible information resources, 4) enhancing communication among laboratory professionals, health care providers and the patient, and 5) advancing the use of diagnostic management teams. Integrating evidence-based laboratory and patient-care quality management approaches may provide a strategy to support diagnostic excellence. Professional societies, government agencies, and healthcare systems are actively engaged in efforts to advance diagnostic excellence. Leveraging clinical laboratory capabilities within a healthcare system can measurably improve the diagnostic process and reduce diagnostic errors. SUMMARY An expanded quality management approach that builds on existing processes and measures can promote diagnostic excellence and provide a pathway to transition innovative concepts to practice. OUTLOOK There are increasing opportunities for clinical laboratory professionals and organizations to be part of a strategy to improve diagnoses.
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Affiliation(s)
- Ira M. Lubin
- Division of Laboratory Systems, Centers for Disease Control and Prevention, 1600 Clifton Rd., NE Mail Stop V24-3, GA 30329, Atlanta, GA, USA
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da Silva RMR, de Mendonça SCB, Leão IN, Dos Santos QN, Batista AM, Melo MS, Xavier MDM, Quintans Júnior LJ, da Silva WB, Lobo IMF. Use of monitoring indicators in hospital management of antimicrobials. BMC Infect Dis 2021; 21:827. [PMID: 34404348 PMCID: PMC8369325 DOI: 10.1186/s12879-021-06542-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background According to the literature, 25% to 50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate, directly impacting antimicrobial resistance. Thus, the present study aimed to evaluate the use of antimicrobials in a university hospital in Northeast Brazil, using days of therapy (DOT) and length of therapy (LOT) indicators in accordance with the latest national and international recommendations for monitoring the use of antimicrobials. Methods This is an observational, prospective analytical study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology department (PNE/INF) and pediatrics (PED). The duration of the study was from the beginning of January to the end of December 2018. Results During the study period, a total of 11,634 patient-days were followed up and 50.4% of the patients were found to have received some antimicrobial, with a significant reduction in use of 1% per month throughout the year. Patients were receiving antimicrobial therapy for 376 days in every 1000 days of hospitalization (LOT = 376/1000pd). Overall, the 1st-generation cephalosporins and fluoroquinolones were the most used in respect of the number of prescriptions and the duration of therapy. The calculated global DOT/LOT ratio showed that each patient received an average of 1.5 antimicrobials during the hospital stay. The incidence of antimicrobial resistance, globally, for both methicillin-resistant Staphylococcus aureus (methicillin R), Carbapenem-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii (Carbapenem R), was 1 per 1000 patient-days. Conclusions The results obtained from the analyses revealed that half of the patients admitted to the hospital who took part in the study were exposed to the use of antimicrobials at some point during their stay. Although moderate, it is noteworthy that there was a decline in the use of antimicrobials throughout the year. The indicators used in this study were found to be very effective for gathering data on the use of antimicrobials, and assessing the results of the initiatives taken as part of the Stewardship program. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06542-5.
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Affiliation(s)
| | | | | | | | | | - Matheus Santos Melo
- Department of Nursing, Federal University of Sergipe, São Cristóvão, Se, Brazil
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Abstract
Hospitalists represent a rapidly emerging specialty group that treats a large proportion of hospitalized patients with infections. Antimicrobial stewardship programs and hospitalist groups that focus on building a collaborative approach have been extremely successful in optimizing antimicrobial prescribing and improving patient outcomes. We discuss the tools needed to build collaborative relationships, summarize published examples of successful stewardship-hospitalist collaboration, and provide guidance on developing collaborative interventions.
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Affiliation(s)
- Megan Mack
- Department of Internal Medicine, Michigan Medicine, University of Michigan, School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Adamo Brancaccio
- Department of Pharmacy Services, Michigan Medicine, University of Michigan, College of Pharmacy, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kayla Popova
- Department of Pharmacy Services, Michigan Medicine, University of Michigan, College of Pharmacy, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jerod Nagel
- Department of Pharmacy Services, Michigan Medicine, University of Michigan, College of Pharmacy, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Kuruc Poje D, Mađarić V, Janeš Poje V, Kifer D, Howard P, Marušić S. Antimicrobial stewardship effectiveness on rationalizing the use of last line of antibiotics in a short period with limited human resources: a single centre cohort study. BMC Res Notes 2019; 12:531. [PMID: 31429801 PMCID: PMC6702748 DOI: 10.1186/s13104-019-4572-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/13/2019] [Indexed: 12/04/2022] Open
Abstract
Objective Antibiotics reserve (ARs) are given as a last line of treatment when other antibiotics are no longer effective. Rising threat of antimicrobial resistance makes growing use of ARs a real problem to patient safety. A single centre interventional cohort study was conducted in order to measure impact on clinical outcomes of A-team programme with limited human resources in a short period. A-team programme started on 01. September 2017. Results In 3 months preintervention and 3 months intervention period, from 3038 and 3156 hospitalized adult patients, 249 (59% of them were male, median age = 69 years) and 96 (51% of them were male, median age = 70 years) received parenteral ARs. Total duration of hospitalization of patients on AR was reduced from 28 to 17 days of hospitalization on 100 patient-days (OR = 1.92; 95% CI 1.83–2.01; p < 0.001) with no statistical significant difference in rehospitalisation due to infection of patients that were treated with ARs within 2 months after discharge. Despite short period of time and limited human resources, A-team restrictive interventions rationalised parenteral AR use and led to positive impact on clinical outcomes. These results could help our and other A-teams in similar situation in continuing with the programme to bring more evidence.
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Affiliation(s)
- Darija Kuruc Poje
- Hospital Pharmacy Ward, General Hospital "Dr. Tomislav Bardek", Željka Selingera 1, 48 000, Koprivnica, Croatia.
| | - Vesna Mađarić
- Pulmology and Infectology Ward, General Hospital "Dr. Tomislav Bardek", Željka Selingera 1, 48 000, Koprivnica, Croatia
| | - Vlatka Janeš Poje
- Clinical Microbiology Ward, Department of Public Health Koprivnica County, Željka Selingera 1, 48 000, Koprivnica, Croatia
| | - Domagoj Kifer
- Department of Biophysics, Faculty of Pharmacy and Biochemistry, University of Zagreb, A Kovačića 1, 10 000, Zagreb, Croatia
| | - Philip Howard
- Leeds Institute of Diagnostics and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Srećko Marušić
- Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Hospital Dubrava, Avenija Gojka Šuška 6, 10 000, Zagreb, Croatia
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Restriction-free antimicrobial stewardship initiative targeting fluoroquinolone reduction across a regional health-system. Infect Prev Pract 2019; 1:100019. [PMID: 34368680 PMCID: PMC8335920 DOI: 10.1016/j.infpip.2019.100019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/19/2022] Open
Abstract
Background Fluoroquinolone (FQ) antibiotics have become a target of many antimicrobial stewardship programmes. Multiple post-marketing warnings from the Food and Drug Administration caution against use of this drug class for certain infections due to risk of harmful adverse effects outweighing benefit. Commonly employed strategies to affect antibiotic prescribing can be restrictive and without improvement in overall antibiotic appropriateness or decrease in collateral damage. Aim To develop a strategy for sustainable optimization of FQ antibiotics. Setting Multi-state health-system of 14 hospitals and medical centers. Methods The health-system antimicrobial stewardship program identified the opportunity to improve FQ utilization. In collaboration with our data and analytics team, specific targets of FQ use in pneumonia and chronic obstructive pulmonary disease were established. Face-to-face provider education and prospective audit and feedback were the mainstays of the campaign. Enhancements to the electronic medical record to support the initiative were also implemented. Findings There was an overall decrease in FQ utilization by 56.9%. For pneumonia use of FQs decreased from 16.4% to 8.1% and in COPD changed from 29.6% to 9.7% over the same time period. Conclusions A non-restrictive FQ optimization initiative based on education and feedback decreased both FQ consumption and total antibiotic use across a large multi-hospital health-system.
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