Clinical pharmacists enhance an antimicrobial stewardship program in Thailand
Methods: From 1/1/12-9/30/12, all patients with infections admitted to 4 medicine units were prospectively followed until hospital discharge for the impact of ASP with or without IDC for outcomes: inappropriate antibiotic use, antibiotic de-escalation, duration of antibiotic use, hospital length of stay (LOS), and mortality. Patients were retrospectively categorized as patients who had CP input without IDC (Group 1), CP input and IDC (Group 2), and no CP input or IDC (Group 3). All groups received basic ASP supervised by hospital pharmacy during the study period. CP was responsible for making daily rounds, alert treating physicians on antibiotic use, and reminders on antibiotic de-escalation. Appropriate antibiotic use was retrospectively evaluated for prehoc prescribing criteria.
Results: The cohort was comprised of 574 patients (G1 = 104; G2 = 320; G3 = 150), with no difference in demographics in G1 and G2. Compared to G3, G1 and G2 patients were more likely to have comorbidities and advanced age. Most antibiotic prescriptions were for empirical therapy (373/574; 65%) while antibiotic prescriptions were most often prescribed for respiratory tract infection (287/574; 50%). By multivariate analysis, G1 was associated with <7days duration of antibiotic use (adjusted Odds Ratio 19.6; P<0.001), while G2 was associated with less inappropriate antibiotic use (aOR = 0.03; P<0.001), antibiotic de-escalation (aOR = 3.7; P<0.001), and <7 days duration of antibiotic use (aOR = 6.81; P<0.001). Compared to G3 (as reference), G1 and G2 were less likely to be prescribed inappropriate antibiotic use (P<0.001), have de-escalation of antibiotics (P<0.001), receive antibiotics <7 days (P<0.001) and have subjects with shorter hospital LOS (P<0.001). There were no group differences in mortality.
Conclusion: This study suggests the feasibility and efficacy of ASP featuring CP, with or without IDC, among hospitalized patients in Thailand. Appropriate antibiotic use, antibiotic de-escalation, <7 day antibiotic regimens, and shorter hospital LOS was associated with CP participation on medical teams.
P. Vanichkul, None
T. Srisaeng-Ngoen, None
L. Mundy, None