Vol.63 No.6 November 2015
The system construction of early pharmacist intervention for patients with bacteremia and the effect of this system
1)Department of Pharmacy, Yokohama General Hospital, 2201-5 Kurogane, Aoba-ku, Yokohama, Kanagawa, Japan
2)Department of Internal Medicine, Yokohama General Hospital
3)Division of General Internal Medicine, St. Marianna University School of Medicine
Abstract
Purpose: In Yokohama General Hospital, we established the system by which pharmacists received blood culture-positive interim reports from 2012, and we tried early intervention for patients with bacteremia by pharmacists. The aim of this study was to evaluate the effect of early intervention by pharmacists.
Method: We classified bacteremia patients in two groups, namely the intervention group for the initial therapy (pharmacists intervened in the initial therapy before starting antimicrobial therapy) and the non-intervention group for the initial therapy (pharmacists did not intervene in the initial therapy) between April, 2012 and November, 2013. In additon, we evaluated the effect of pharmacists' intervention in both groups using the rate of adequate antimicrobial therapy that was calculated with the Kaplan-Meier method. In addition, we further classified patients into the adequate therapy group and the inadequate therapy group from the initial therapy, and evaluated the association between the adequate initial therapy and nosocomial infection, prior treatment with broad-spectrum antimicrobial agents and pharmacists' intervention using a multivariate analysis.
Results: The cumulative achievement rate of the adequate antimicrobial therapy was 82.1% at day 1, 85.7% at day 2, 96.4% at day 4 in intervention group for the initial therapy and 47.2% at day 1, 50.0% at day 2, 77.8% at day 3, 86.1% at day 4 in non-intervention group for the initial therapy. The cumulative achievement rate of the adequate antimicrobial therapy in the intervention group for the initial therapy was significantly higher than the non-intervention group (p=0.03). In addition, from the result of the multivariate analysis, prior treatment with broad-spectrum antimicrobial agents significantly decreased the rate of the adequate initial therapy (adjusted odds ratio 0.06 [95% confidence interval, 0.01-0.35]) and pharmacists' intervention significantly increased the rate of the adequate initial therapy (adjusted odds ratio 7.4 [95% confidence interval, 1.67-32.89]).
Conclusion: It was suggested by this investigation that early pharmacists' intervention for patients with bacteremia was able to lead to an early and adequate antimicrobial therapy.
Key word
bacteremia, antimicrobial agents, appropriate use
Received
December 22, 2014
Accepted
September 1, 2015
Jpn. J. Chemother. 63 (6): 544-552, 2015
