Search

Background: A prospective audit with intervention and feedback (PAF) by pharmacists is important for the appropriate use of antimicrobials. Clinically, Escherichia coli (E. coli) bacteremia is a common condition, but only few researchers have examined the role of PAF in its appropriate use of antimicrobials., Methods: We started PAF by pharmacists in 2017 for all injectable antibiotics. This study included cases of E. coli bacteremia that resulted in hospitalization over a 4 year period from 2016 to 2019. Patients were grouped by year (Period 0-3), and clinical outcomes were examined., Results: The pharmacists had 12 and 54 suggestions in Periods 0 and 3, respectively. The most common suggestion was de-escalation. The median duration of antimicrobial use was 12 (interquartile range: 8-15) days in Periods 0-2. The duration of antimicrobial use was significantly reduced to 9 (7-12) days in Period 3. In Period 3, the duration of antimicrobial use was reduced by 29%, while anti-pseudomonal drug use was reduced by 42% compared with that in period 0. The 30 day mortality rates were not significantly different between the groups., Conclusions: PAF by pharmacists promotes the appropriate use of antimicrobials in patients with E. coli bacteremia; it is important to continue the program for several years., (Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Prospective audit with intervention and feedback (PAF) and preauthorisation of antimicrobials are core strategies for antimicrobial stewardship (AS). PAF participants were expanded from patients using specific antibiotics to those using whole injectable antibiotics to evaluate clinical outcome. From January 2016 to December 2016, PAF was performed in patients using specific antibiotics (period 1) and from January 2017 to December 2017, PAF was performed in patients using whole injectable antibiotics (period 2). PAF was implemented for 5 days every week by pharmacists involved in infectious diseases chemotherapy. In total, 11,571 and 11,103 patients used antibiotic injections during periods 1 and 2, respectively. No significant difference in mortality within 30 days from the initial use of injection antibiotics was observed. The average duration of hospitalisation was significantly shorter during period 2 among patients using antibiotics; however, this was not significantly different from that of patients not receiving antibiotics. The average duration of therapy for intravenous antibiotics was significantly shorter during period 2 than during period 1. The ratio of methicillin-resistant Staphylococcus aureus (MRSA) to S. aureus was significantly low during period 2. The duration of intravenous antibiotic therapy for Escherichia coli bacteraemia during period 2 decreased significantly. De-escalation and appropriate antimicrobial treatment rates at specific doses during period 2 increased significantly. Expansion of patients eligible for PAF from patients using specific antibiotics to patients using whole injectable antibiotics shortened hospital stays, suppressed drug resistance, and promoted the appropriate use of antibiotics.

Existing recommendations regarding pharmaceutical interventions for patients with coronavirus disease 2019 (COVID-19) focus on outpatient, inpatient and post-discharge care. However, there are no studies examining the actual activities of pharmacists in relation to hospitalised patients. The present study aimed to identify pharmacists' roles by analysing cases of pharmaceutical interventions, particularly for patients admitted to high-care units. Pharmacological interventions were provided to patients with severe COVID-19 or patients at high risk of severe disease in 2021. These pharmaceutical interventions were analysed and evaluated. Pharmacists also developed a COVID-19 drug compatibility chart for use by care team members. In the present study, 54 patients were included, of which 33 were severe cases. A total of 28 patients (52%) received pharmacological interventions and 25 of them were severe cases. Out of 68 pharmacological interventions, interventions for antimicrobial agents were the most common (28 interventions), followed by nutrition and anti-COVID-19 drug-related interventions. In addition, the need for interventions relating to drug compatibility was reduced by ~43% after the drug compatibility chart was implemented. In conclusion, pharmacists have a responsibility to improve the quality of pharmacotherapy for patients with COVID-19. They should focus on creating specific pharmacotherapy tools for patients with COVID-19 and supporting appropriate antimicrobial use for secondary bacterial infections. [ABSTRACT FROM AUTHOR]