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Few studies have analyzed community hospital-based parenteral anti-infective therapy (CohPAT). We aimed to assess the clinical impact of a pharmacist-led implementation of a clinical practice guideline (CPG) for CohPAT, and to determine the pharmacist’s role in CohPAT medication management. The prospective-period patients (post-implementation group) were compared with the historical control-period patients (pre-implementation group) for receiving a continuous antimicrobial parenteral injection. A CPG was used for laboratory testing for efficacy and safety, the monitoring of adverse drug events during admission, microbiology results coordination, and dosage adjustment. For any antimicrobial drug-related problems, the pharmacist consulted with the clinicians. Over 14 months, 50 participants were included in each group. In the pre-implementation period, 7 (14%) and 4 (8%) out of 50 patients received an inappropriate dosage and nonlaboratory monitoring for dose adjustment, respectively. The patients received the proper dosage of antimicrobial agents, which increased significantly from 78% pre- to 100% post-implementation (p = 0.000). The pharmacist’s interventions during the prospective-period were completely accepted by the clinicians, and significantly greater laboratory monitoring complying with CPG was given to the postimplementation group than the pre-implementation group (100% vs. 60%; p = 0.000). Significantly less patients with unfavorable outcomes (failure or in-hospital mortality) were observed in the post-implementation than in the pre-implementation (6% vs. 26%; p = 0.006) group. For the logistic regression analysis, lower respiratory infection (adjusted OR, aOR 3.68; 95%CI 1.13–12.06) and the post-implementation period (aOR 0.21; 95%CI 0.06–0.83) were significant risk factors that were associated with unfavorable outcomes. Given the better clinical outcomes and the improved quality of septic patient care observed after implementation, pharmacist-led implementation should be adopted in healthcare settings.

Background: Stenotrophomonas maltophilia is a multidrug-resistant bacteria that is difficult to treat in hospitals around the world. It has become a public health issue, as well as being linked to a high mortality rate. Several studies have shown a variety of treatment and clinical outcomes; however, the efficacy of combination therapy remains limited. Therefore, the purpose of this study is to investigate the effect of monotherapy and combination therapy for S. maltophilia infections on mortality outcome.Methods: We performed a systematic review and meta-analysis of combination therapy versus monotherapy in the treatment of S. maltophilia infections on mortality as a clinical outcome. Electronic databases, including Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, Scopus, and OpenGrey, were systematically searched from the inception of the database until September 3, 2021. Results: Of which 6,524 articles identified, a total of 13 studies and 2 cohort studies were included for systematic review of combination therapy and meta-analysis, respectively. The systematic review of combination antimicrobial therapy had been showed clinically desirable outcome on mortality in S. maltopholia infection, especially in complex or severe infection. In the fixed-effects meta-analysis of the cohort study, monotherapy was surprisingly shown to have statistically significant effects on the decreased risk of mortality (hazard ratio 1.42; 95% confidence interval, 1.04-1.94). Conclusions: Our results found that the combination antimicrobial therapy had been showed clinically desirable outcome on mortality in S. maltopholia infection and monotherapy has a trend toward improved better outcome than combination therapy on mortality for the treatment of S. maltophilia infections. A longitudinal study that further explores this association is warranted. Trial registration: This study was registered with the trial registration number ID: 210843 under the international prospective register of systematic reviews (PROSPERO: www.crd.york.ac.uk/PROSPERO).