Vol.66 No.5 September 2018

Evaluation of the efficacy of pharmacist-driven support for infectious diseases through an antimicrobial stewardship program for Staphylococcus aureus bacteremia

Masaru Samura¹⁾, Naoki Hirose¹⁾, Takenori Kurata¹⁾, Junichi Ishii¹⁾, Fumio Nagumo¹⁾, Keisuke Takada¹⁾, Sakura Koshioka¹⁾, Masaki Uchida¹⁾, Syunya Yamamoto¹⁾, Junki Inoue¹⁾, Hisakazu Sekine¹⁾, Akira Ishida²⁾, Norifumi Kunika²⁾ and Hiroyuki Kunishima³⁾

¹⁾Department of Pharmacy, Yokohama General Hospital, 2201-5 Kurogane Aoba-ku, Yokohama, Kanagawa, Japan
²⁾Internal Medicine, Yokohama General Hospital
³⁾Department of Infectious Disease, St. Marianna University School of Medicine

Abstract

Staphylococcus aureus bacteremia (SAB) is a high-mortality infectious disease and may cause complications such as infective endocarditis, abscess formation, or osteomyelitis. Therefore, it is very important to select appropriate antimicrobial agents at an early stage and to adhere to treatment for more than 14 days.
Although the Yokohama General Hospital is a medium-sized hospital with 300 beds, full-time infectious disease specialists are lacking. Therefore, pharmacists of the Certified Infectious Disease Chemotherapy Pharmacists (CIDCPs) group have implemented an antimicrobial stewardship program in which CIDCPs assist physicians and ward-pharmacists to evaluate interim and final reports of blood culture, and provide support for appropriate infectious disease treatment.
In this study, we evaluated the 30-day survival rate and adherence to cumulative use of appropriate antimicrobial agents, treatment with antimicrobial agents for more than 14 days, re-examination of blood culture, and implementation of transthoracic echocardiography in the pre-ASP (2008-2011) and post-ASP (2012-2015) periods. Results showed that the 30-day survival rate as one of the outcome indicators was 80.0% (20/25) in the pre-ASP period, and 81.3% (39/48) in the post-ASP period, which was not a significant difference. Although adherence to the cumulative use of appropriate antimicrobial agents for SAB and MSSA bacteremia as process indicators was not significantly different between the pre-ASP and post-ASP groups, that for MRSA was significantly different (p=0.02). Treatment adherence for more than 14 days in the pre-ASP and post-ASP groups as one of the process indicators was 48.0% (12/25) and 79.2% (38/48) (p< 0.01), respectively; adherence to re-examination of blood culture as one of the process indicators was 36.0% (9/25) and 56.3% (27/48) (p=0.13), respectively; and adherence to implementation of transthoracic echocardiography as one of the process indicators was 36.0% (9/25) and 47.9% (23/48) (p=0.46), respectively. In a multivariate analysis, factors which increased mortality were MRSA bacteremia (odds rate 4.34, 95% confidence interval 1.10-22.90), unknown infection sites (odds rate 5.87, 95% confidence interval 1.43-29.98), and infective endocarditis (odds rate 4.00, 95% confidence interval 1.06-244.47). In conclusion, although this study found that pharmacist-driven ASP did not improve 30-day survival as one of the outcome indicators, it improved adherence to appropriate antimicrobial therapy for MRSA, the appropriate treatment duration for SAB, and the rate of the target trough concentration of vancomycin as process indicators.

Key word

antimicrobial stewardship, Staphylococcus aureus bacteremia, pharmacists

Received

September 25, 2017

Accepted

May 2, 2018

Jpn. J. Chemother. 66 (5): 587-599, 2018