Vol.66 No.5 September 2018
Impact of pharmacist support on quality of care and clinical outcome in Staphylococcus aureus bacteremia
1)Department of Pharmacy, Fujisawa city Hospital, 2-6-1 Fujisawa, Fujisawa, Kanagawa, Japan
2)Department of Clinical Laboratory, Fujisawa city Hospital
3)Department of Nursing, Fujisawa city Hospital
4)Department of Respiratory medicine, Fujisawa city Hospital
5)Department of Respiratory surgery, Fujisawa city Hospital
Abstract
The aim of this study was to assess the impact of infectious disease chemotherapy pharmacist's and ward pharmacist's support in the management of patients with Staphylococcus aureus bacteremia (SAB). A retrospective observational cohort study was performed in patients with SAB from July 2012 to June 2013 (pre-support period) and from July 2014 to June 2016 (supported period).
The 90-day survival rate and 180-day recurrence rate, the quality of management including the duration of antibiotic therapy, repeat blood culture and echocardiography were compared between the pre-support and supported period.
A total of 46 and 71 patients were included in the pre-support and supported period, respectively. The difference in the 90-day cumulative survival rate was not statistically significantly different between 86.7% (pre-support period) and 85.2% (support period). However, in the pre-support period, 2 cases of bacteremia and 1 case of psoas abscess were observed within 180 days, and there was a statistically significant difference in the cumulative recurrence rate (P=0.032). As a result of examining the treatment period among the factors that may affect recurrence, the proportion of inappropriate antibiotic therapy (< 14 days) was significantly different (P=0.041) between 43.5% (pre-support period) and 25.4% (support period). In addition, multivariate analysis results showed that pharmacist support tended to lower the rate of inappropriate duration of antibiotic therapy (adjusted odds ratio 0.446 [95% CI, 0.197-1.011]) after controlling for potential confounders (i.e. MRSA, infectious endocarditis, abscess, bone and joint infection). Blood cultures were repeated within 2-4 days of bacteremia in 2.2% (pre-support period) and 15.5% (supported period) patients (P=0.020). Our study shows a tendency towards reduction of the recurrence rate with pharmacist support improved management of patients with SAB.
Key word
Staphylococcus aureus bacteremia, appropriate use
Received
October 2, 2017
Accepted
April 4, 2018
Jpn. J. Chemother. 66 (5): 578-586, 2018
