Effects of Pharmacist Participation in a Carbapenem Antimicrobial Stewardship Program on Appropriate Antibiotic Use
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Abstract
Antimicrobial Stewardship Program (ASP) is the process that apply in the practice for solving the antimicrobial resistance, which needs to be integrated the knowledge of pharmacotherapy in infectious diseases. Objective: This study was to evaluate the effect of pharmacists, who participate in changing and guidance of antimicrobial use in the program, on the appropriateness of prescribing, number of carbapenems use, and clinical outcome. Method: Patients who had received carbapenems (ertapenem, meropenem and imipenem) at Warinchumrab hospital during April 2020 to March 2021 were retrospectively reviewed by medical records. Two groups were classified according to the period of without pharmacist involved in ASP (Apr. 2020 – Sep. 2020) and pharmacist involved in ASP (Oct. 2020 – Mar. 2021). The appropriateness of prescription, antibiotic consumption in terms of Defined Daily Dose, and Days of Therapy/1,000 patient-days were compared. Results: Among the 485 included patients, there were 269 and 216 patients in the period of without pharmacist involved and pharmacist involved in ASP, respectively. The rate of appropriateness of prescription statistically increased from 92.9% to 98.2% after having pharmacist in the program (p-value 0.007). The appropriate dosing also significantly increased from 77.0% to 80.4% (p-value = 0.002). Although, the antibiotic consumption in terms of Defined Daily Dose/1,000 patient-days and Days of Therapy/1,000 patient-days were not significant difference between pre- and post- ASP. However, there was a trend toward decreasing of carbapenems use. Conclusion: Pharmacist involved in the ASP can increase the appropriateness of antimicrobial prescribing according to indication and dosing, which promote the greatest benefit of carbapnems use for patient in Warinchamrab hospital. Furthermore, the antibiotic consumption tends to decrease. However, the effects on mortality rate are still unclear, which needs further study.
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