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Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection

Evidence for the utility of pharmacist-driven antimicrobial stewardship programs remains limited. This study aimed to evaluate the usefulness of our institutional pharmacist-driven prospective audit with intervention and feedback (PAF) on the treatment of patients with bloodstream infections (BSIs)....

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Autores principales: Okada, Naoto, Azuma, Momoyo, Tsujinaka, Kaito, Abe, Akane, Takahashi, Mari, Yano, Yumiko, Sato, Masami, Shibata, Takahiro, Goda, Mitsuhiro, Ishizawa, Keisuke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495130/
https://www.ncbi.nlm.nih.gov/pubmed/36139925
http://dx.doi.org/10.3390/antibiotics11091144
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author Okada, Naoto
Azuma, Momoyo
Tsujinaka, Kaito
Abe, Akane
Takahashi, Mari
Yano, Yumiko
Sato, Masami
Shibata, Takahiro
Goda, Mitsuhiro
Ishizawa, Keisuke
author_facet Okada, Naoto
Azuma, Momoyo
Tsujinaka, Kaito
Abe, Akane
Takahashi, Mari
Yano, Yumiko
Sato, Masami
Shibata, Takahiro
Goda, Mitsuhiro
Ishizawa, Keisuke
author_sort Okada, Naoto
collection PubMed
description Evidence for the utility of pharmacist-driven antimicrobial stewardship programs remains limited. This study aimed to evaluate the usefulness of our institutional pharmacist-driven prospective audit with intervention and feedback (PAF) on the treatment of patients with bloodstream infections (BSIs). The effect of pharmacist-driven PAF was estimated using an interrupted time series analysis with a quasi-experimental design. The proportion of de-escalation during BSI treatment increased by 44% after the implementation of pharmacist-driven PAF (95% CI: 30–58, p < 0.01). The number of days of therapy decreased by 16 per 100 patient days for carbapenem (95% CI: −28 to −3.5, p = 0.012) and by 15 per 100 patient days for tazobactam/piperacillin (95% CI: −26 to −4.9, p < 0.01). Moreover, the proportion of inappropriate treatment in empirical and definitive therapy was significantly reduced after the implementation of pharmacist-driven PAF. Although 30-day mortality did not change, compliance with evidenced-based bundles in the BSI of Staphylococcus aureus significantly increased (p < 0.01). In conclusion, our pharmacist-driven PAF increased the proportion of de-escalation and decreased the use of broad-spectrum antibiotics, as well as the proportion of inappropriate treatment in patients with BSI. This indicates that pharmacist-driven PAF is useful in improving the quality of antimicrobial treatment and reducing broad-spectrum antimicrobial use in the management of patients with BSI.
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spelling pubmed-94951302022-09-23 Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection Okada, Naoto Azuma, Momoyo Tsujinaka, Kaito Abe, Akane Takahashi, Mari Yano, Yumiko Sato, Masami Shibata, Takahiro Goda, Mitsuhiro Ishizawa, Keisuke Antibiotics (Basel) Article Evidence for the utility of pharmacist-driven antimicrobial stewardship programs remains limited. This study aimed to evaluate the usefulness of our institutional pharmacist-driven prospective audit with intervention and feedback (PAF) on the treatment of patients with bloodstream infections (BSIs). The effect of pharmacist-driven PAF was estimated using an interrupted time series analysis with a quasi-experimental design. The proportion of de-escalation during BSI treatment increased by 44% after the implementation of pharmacist-driven PAF (95% CI: 30–58, p < 0.01). The number of days of therapy decreased by 16 per 100 patient days for carbapenem (95% CI: −28 to −3.5, p = 0.012) and by 15 per 100 patient days for tazobactam/piperacillin (95% CI: −26 to −4.9, p < 0.01). Moreover, the proportion of inappropriate treatment in empirical and definitive therapy was significantly reduced after the implementation of pharmacist-driven PAF. Although 30-day mortality did not change, compliance with evidenced-based bundles in the BSI of Staphylococcus aureus significantly increased (p < 0.01). In conclusion, our pharmacist-driven PAF increased the proportion of de-escalation and decreased the use of broad-spectrum antibiotics, as well as the proportion of inappropriate treatment in patients with BSI. This indicates that pharmacist-driven PAF is useful in improving the quality of antimicrobial treatment and reducing broad-spectrum antimicrobial use in the management of patients with BSI. MDPI 2022-08-24 /pmc/articles/PMC9495130/ /pubmed/36139925 http://dx.doi.org/10.3390/antibiotics11091144 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Okada, Naoto
Azuma, Momoyo
Tsujinaka, Kaito
Abe, Akane
Takahashi, Mari
Yano, Yumiko
Sato, Masami
Shibata, Takahiro
Goda, Mitsuhiro
Ishizawa, Keisuke
Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection
title Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection
title_full Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection
title_fullStr Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection
title_full_unstemmed Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection
title_short Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection
title_sort clinical impact of a pharmacist-driven prospective audit with intervention and feedback on the treatment of patients with bloodstream infection
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495130/
https://www.ncbi.nlm.nih.gov/pubmed/36139925
http://dx.doi.org/10.3390/antibiotics11091144
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