Vol.71 No.3 May 2023
Impact of assigning a full-time antimicrobial stewardship team pharmacist on appropriate use of antimicrobial agents and changes in antibiotic usage in a regional medical care support hospital
1)Department of Pharmacy, National Hospital Organization, Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa, Japan
2)Antimicrobial stewardship team, National Hospital Organization, Sagamihara National Hospital
3)Department of Surgery, National Hospital Organization, Sagamihara National Hospital
4)Department of Emergency and Critical Care Medicine, National Hospital Organization, Sagamihara National Hospital
5)Department of Allergy and Respiratory Medicine, National Hospital Organization, Sagamihara National Hospital
6)Department of Nursing, National Hospital Organization, Sagamihara National Hospital
7)Department of Clinical Laboratory, National Hospital Organization, Sagamihara National Hospital
Abstract
Antimicrobial resistance has become a global problem, and antimicrobial stewardship (AS) is required at each medical institution. In October 2021, a pharmacist was assigned to the antimicrobial stewardship team (AST) as a full-time employee (full-time AST pharmacist) at the Sagamihara National Hospital to promote appropriate usage of antibiotics. After the full-time assignment, daily post-prescription review with feedback (PPRF) for patients receiving broad-spectrum antibiotics was initiated. There have been few reports on the impact of assignment of a full-time AST pharmacist in regional medical care support hospitals, and the purpose of this study was to clarify the impact of such assignment on the status of antimicrobial stewardship support and antimicrobial usage at Sagamihara National Hospital.
In this study, we compared the antimicrobial stewardship support status, amount of antimicrobial used, Pseudo-monas aeruginosa resistance rate, and incidence rate of Clostridioides difficile infection during the 6-month period after assignment of the full-time AST pharmacist ('post' period; October 2021 to March 2022) as compared with the 6-month period prior to assignment of the full-time AST pharmacist ('pre' period; April 2021 to September 2021).
The duration of treatment with broad-spectrum antibiotics was significantly shorter in the 'post' as compared with the 'pre' period (7 days [5-10 days] vs. 6 days [4-9 days]; p<0.05). The percentage of patients receiving long-term broad-spectrum antibiotics was also significantly lower in the 'post' as compared with the 'pre' period (13.4% vs. 6.8%; p<0.05). The antimicrobial stewardship support rate was significantly higher in the 'post' as compared with the 'pre' period (9.7% vs. 33.4%; p<0.001). The days of therapy (DOT) for meropenem, tazobactam/piperacillin, and fluoroquinolones were significantly lower in the 'post' as compared with the 'pre' period (p<0.05). The total amount spent on broad-spectrum and non-broad-spectrum antibiotics was lower by ¥2,832,345 during the 'post' as compared with the 'pre' period.
The results of this study suggest that in regional medical care support hospitals, assigning a full-time AST pharmacist and daily PPRF for patients receiving broad-spectrum antibiotics could be expected to increase antimicrobial stewardship support and reduce the usage of and expenditure on antibiotics. On the other hand, the degree of effectiveness of an AST is greatly affected by the size of a medical institution, the facilities available, and the state of antimicrobial usage at the institution, so that it is necessary to accumulate and evaluate the effects of assigning a full-time AST pharmacist in each type of medical institution.
Key word
antimicrobial stewardship team, postprescription review with feedback, full-time equivalent, broad spectrum antibacterial agents
Received
January 13, 2023
Accepted
March 7, 2023
Jpn. J. Chemother. 71 (3): 311-325, 2023
