Evaluation of a clinical pharmacist-led antimicrobial stewardship program in a neurosurgical intensive care unit: a pre-and post-intervention cohort study
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作者:
Yu, Jing
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Hebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Hebei Med Univ, Hosp 1, Technol Innovat Ctr Artificial Intelligence Clin P, Shijiazhuang, Peoples R ChinaHebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Yu, Jing
[1
,2
]
Liu, Yan
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机构:
Hebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Hebei Med Univ, Hosp 1, Technol Innovat Ctr Artificial Intelligence Clin P, Shijiazhuang, Peoples R ChinaHebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Liu, Yan
[1
,2
]
Qu, Ruochen
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机构:
Hebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Hebei Med Univ, Hosp 1, Technol Innovat Ctr Artificial Intelligence Clin P, Shijiazhuang, Peoples R ChinaHebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Qu, Ruochen
[1
,2
]
Wang, Ziyang
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机构:
Hebei Med Univ, Dept Clin Pharm, Shijiazhuang, Peoples R ChinaHebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Wang, Ziyang
[3
]
Zhao, Yan
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机构:
Hebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Hebei Med Univ, Hosp 1, Technol Innovat Ctr Artificial Intelligence Clin P, Shijiazhuang, Peoples R ChinaHebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Zhao, Yan
[1
,2
]
Zhao, Yuanyuan
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机构:
Hebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Hebei Med Univ, Hosp 1, Technol Innovat Ctr Artificial Intelligence Clin P, Shijiazhuang, Peoples R ChinaHebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Zhao, Yuanyuan
[1
,2
]
Zhou, Chunhua
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机构:
Hebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Hebei Med Univ, Hosp 1, Technol Innovat Ctr Artificial Intelligence Clin P, Shijiazhuang, Peoples R ChinaHebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
Zhou, Chunhua
[1
,2
]
机构:
[1] Hebei Med Univ, Hosp 1, Dept Clin Pharm, Shijiazhuang, Peoples R China
[2] Hebei Med Univ, Hosp 1, Technol Innovat Ctr Artificial Intelligence Clin P, Shijiazhuang, Peoples R China
[3] Hebei Med Univ, Dept Clin Pharm, Shijiazhuang, Peoples R China
microbial;
mortality;
antimicrobial stewardship;
neurosurgical intensive care units;
drug resistance;
CRITICALLY-ILL PATIENTS;
MULTICENTER;
MENINGITIS;
GUIDELINES;
MANAGEMENT;
D O I:
10.3389/fphar.2023.1263618
中图分类号:
R9 [药学];
学科分类号:
1007 ;
摘要:
Background: Antimicrobial resistance poses a significant challenge in neurosurgical intensive care units (ICU). The excessive use of broad-spectrum antibiotics is closely linked to the emergence and dissemination of drug-resistant bacteria within neurosurgical ICUs. This study assessed the effects of implementing a comprehensive Antimicrobial Stewardship (AMS) program in a neurosurgical ICU setting.Methods: From April 2022 to September 2022, an AMS program was implemented in the neurosurgical ICU. The program involved the regular presence of a pharmacist and an infectious disease physician who conducted prospective audits and provided feedback. To assess the impact of the AMS program, the outcome measures were compared between the AMS period and the 6 months before AMS implementation (pre-AMS period). The primary outcome was the use of antibacterial agents, including anti-pseudomonal beta-lactams (APBLs), polymyxin, and tigecycline. Additionally, the study evaluated the appropriateness of antimicrobial de-escalation and the susceptibility of Gram-negative bacilli to antimicrobial agents.Results: A total of 526 were included during the AMS period, while 487 patients were included in the pre-AMS period. The two groups had no significant differences in disease severity and mortality rates. During the AMS period, there was a notable decrease in the use of APBLs as empiric treatment (43.92% vs. 60.99%, p < 0.001). Multi-drug resistant organism (MDRO) infections decrease significantly during AMS period (11.03% vs. 18.48%, p < 0.001). The number of prescription adjustment increased significantly in all patients (0 item vs. 0 item, p < 0.001) and MDRO-positive patients (3 items vs. 2 items, p < 0.001) during the AMS period. Additionally, appropriate antimicrobial de-escalation for patients with MDRO showed improvement during the AMS period (39.66% vs. 20%, p = 0.001). Polymyxin utilization also decreased during the AMS period (15.52% vs. 31.11%, p = 0.034). Furthermore, the susceptibility of Gram-negative Bacilli isolates to APBLs was significantly higher during the AMS period.Conclusion: Implementing a comprehensive pharmacist-led AMS program led to a decrease in the use of antibacterial agents. This reduction in usage is significant because it can potentially delay the emergence of bacterial resistance.
机构:
Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
Univ Calif Los Angeles, Fielding Sch Publ Hlth, Ctr Hlth Adv, Los Angeles, CA USAUniv Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
Narain, Kimberly Danae Cauley
Doppee, Danielle
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Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USAUniv Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
Doppee, Danielle
Li, Ning
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Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USAUniv Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
Li, Ning
Moreno, Gerardo
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Univ Calif Los Angeles, David Geffen Sch Med, Dept Family Med, Los Angeles, CA 90095 USAUniv Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
Moreno, Gerardo
Bell, Douglas S.
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h-index: 0
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Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
Univ Calif Los Angeles, Clin & Translat Sci Inst, Los Angeles, CA USAUniv Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
Bell, Douglas S.
Do, Amanda L.
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h-index: 0
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Univ Calif Los Angeles, Clin & Translat Sci Inst, Los Angeles, CA USAUniv Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
Do, Amanda L.
Follett, Robert W.
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Univ Calif Los Angeles, Clin & Translat Sci Inst, Los Angeles, CA USAUniv Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
Follett, Robert W.
Mangione, Carol M.
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Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
Univ Calif Los Angeles, Fielding Sch Publ Hlth, Hlth Policy & Management, Los Angeles, CA USAUniv Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res GIM HSR, 1100 Glendon Ave,Suite 850, Los Angeles, CA 90024 USA
机构:
Farwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, Kuwait
Kuwait Oil Co KOC, Dept Pediat, Gen Ahmadi Hosp, Pediat Intens Care Unit, Al Ahmadi, KuwaitFarwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, Kuwait
Alfraij, Abdulla
Abdelmoniem, Ahmed
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Farwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, KuwaitFarwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, Kuwait
Abdelmoniem, Ahmed
Elseadawy, Mohamed
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Farwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, KuwaitFarwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, Kuwait
Elseadawy, Mohamed
Surour, Mohammad
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Farwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, KuwaitFarwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, Kuwait
Surour, Mohammad
Basuni, Mohamed
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Farwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, KuwaitFarwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, Kuwait
Basuni, Mohamed
Papenburg, Jesse
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机构:
McGill Univ, Hlth Ctr, Dept Pediat & Med Microbiol, Montreal, PQ, CanadaFarwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, Kuwait
Papenburg, Jesse
Alghounaim, Mohammad
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Amiri Hosp, Dept Pediat, Kuwait, Al Asimah, Kuwait
Amiri Hosp, Dept Pediat, 900005 Ibn Misbah St Sharq block 3, Kuwait 2436149, KuwaitFarwaniya Hosp, Dept Pediat, Pediat Intens Care Unit, Al Farwaniya, Kuwait
机构:
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Li, Zhongwang
Cheng, Baoli
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h-index: 0
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Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Cheng, Baoli
Zhang, Kai
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Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhang, Kai
Xie, Guohao
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Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Xie, Guohao
Wang, Yan
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h-index: 0
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Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Wang, Yan
Hou, Jinchao
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h-index: 0
机构:
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Hou, Jinchao
Chu, Lihua
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Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Chu, Lihua
Zhao, Jialian
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Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhao, Jialian
Xu, Zhijun
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机构:Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Xu, Zhijun
Lu, Zhongqiu
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h-index: 0
机构:
Zhejiang Univ, Sch Med, Affiliated Hosp 2, Intens Care Unit, Hangzhou, Zhejiang, Peoples R China
Wenzhou Med Univ, Affiliated Hosp 1, Emergency Intens Care Unit, Wenzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Lu, Zhongqiu
Sun, Huaqin
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h-index: 0
机构:
Zhejiang Chinese Med Univ, Affiliated Hosp 1, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Sun, Huaqin
Zhang, Jian
论文数: 0引用数: 0
h-index: 0
机构:
Hangzhou Normal Univ, Affiliated Hosp, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhang, Jian
Wang, Zhiyi
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h-index: 0
机构:
Wenzhou Med Univ, Affiliated Hosp 2, Emergency Intens Care Unit, Wenzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Wang, Zhiyi
Wu, Haiya
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h-index: 0
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Wenzhou Med Univ, Affiliated Hosp 2, Intens Care Unit, Wenzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Wu, Haiya
Fang, Xiangming
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h-index: 0
机构:
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Intens Care Unit, Hangzhou, Zhejiang, Peoples R ChinaZhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Anesthesiol, Hangzhou, Zhejiang, Peoples R China
机构:
Monash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences
Muhammad Rehan Sarwar
Vanessa Marie McDonald
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机构:
National Health and Medical Research Council,Centre for Research Excellence in Severe Asthma and Centre of Excellence in Treatable TraitsMonash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences
Vanessa Marie McDonald
Michael J. Abramson
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h-index: 0
机构:
The University of Newcastle,Department of Respiratory and Sleep MedicineMonash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences
Michael J. Abramson
Sally Wilson
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h-index: 0
机构:
The Priority Research Centre for Healthy Lungs,School of Public Health and Preventive MedicineMonash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences
Sally Wilson
Anne E. Holland
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h-index: 0
机构:
School of Nursing and Midwifery,School of Translational MedicineMonash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences
Anne E. Holland
Billie Bonevski
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h-index: 0
机构:
Monash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences
Billie Bonevski
Ajay Mahal
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h-index: 0
机构:
John Hunter Hospital,College of Medicine and Public HealthMonash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences
Ajay Mahal
Eldho Paul
论文数: 0引用数: 0
h-index: 0
机构:
Hunter Medical Research Institute,undefinedMonash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences
Eldho Paul
Brian Meier
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h-index: 0
机构:
Monash University,undefinedMonash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences
Brian Meier
Johnson George
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h-index: 0
机构:
School of Nursing and Midwifery,School of Translational MedicineMonash University,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences