Vol.72 No.1 January 2024

Effects of pharmacist-led antimicrobial stewardship on the outcomes of vertebral osteomyelitis

Sayaka Nishimura^{1, 2)}, Toshihiro Sano³⁾, Kyuichi Hashimoto⁴⁾, Takuya Fujichika^{1, 2)}, Ae Okamoto^{1, 5)}, Ritsuko Takano^{1, 6)}, Shingo Yamanaka^{1, 7)} and Masafumi Kawamura^{5, 7)}

¹⁾Department of AST, Kochi Prefectural Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo City, Kochi Prefecture, Japan
²⁾Department of Pharmacy, Kochi Prefectural Hata Kenmin Hospital
³⁾Department of Orthopedics, Susaki Kuroshio Hospital
⁴⁾Department of Orthopedics, Kochi Prefectural Hata Kenmin Hospital
⁵⁾Department of Infection Control Room, Kochi Prefectural Hata Kenmin Hospital
⁶⁾Department of Clinical Laboratory, Kochi Prefectural Hata Kenmin Hospital
⁷⁾Department of Internal Medicine, Kochi Prefectural Hata Kenmin Hospital

Abstract

We launched an antimicrobial stewardship (AS) program led by a Board Certified Pharmacist in Infection Control in 2016, in the absence of an infectious disease physician at our hospital. Since 2020, the antimicrobial stewardship team (AST) has held conferences for infectious diseases with the doctors of the orthopedics department. At these conferences, the AST provides suggestions for the appropriate antimicrobial regimens, appropriate duration of antimicrobial treatment, and monitoring of adverse drug reactions until treatment is completed. While previous reports have revealed the effectiveness of pharmacist-led AS interventions as being effective for patients with positive blood cultures and for controlling the resistance rate, there are no reports as yet about the effect of department-specific conferences on such outcomes. The purpose of this study was to assess the effectiveness of pharmacist-led AS intervention for patients with vertebral osteomyelitis. The subjects were patients with vertebral osteomyelitis, pyogenic spondylodiscitis, and pyogenic facet joint infection who were treated at our orthopedics department between 2012 to 2022, and the following three periods were compared: 1st period, before the AS program was launched, 2nd period, in which the AS intervention was based only on chart rounds, and the 3rd period, in which infection conferences were held. The evaluation criteria were the number of culture specimens, identification rate of pathogens, echocardiography implementation rate, mortality rate, recurrence rate, length of stay, duration of treatment, and the antimicrobials used. A blood culture submission rate of 100% was achieved during the 3rd period, and the number of cultures submitted per patient increased from the 2nd period. The duration of treatment decreased after the start of AS and by half in the 3rd period.

Key word

antimicrobial stewardship, vertebral osteomyelitis, appropriate antimicrobial use, days of treatment

Received

July 26, 2023

Accepted

October 16, 2023

Jpn. J. Chemother. 72 (1): 17-25, 2024