Potential hospital pharmacists' interventions in antibacterial stewardship. Issue 2 (12th March 2012)

• Record Type: Journal Article
• Authors: Rodrigues, J.F.; Casado, A.; Duarte, A.M.; Santos, C.; Duarte, A.; Fernandez-Llimos, F.
• Is Part Of: European journal of hospital pharmacy. Volume 19:Issue 2(2012)
• Page Start: 113
• Page End: 113
• Publication Date: 2012-03-12
• Subjects: Pharmacy -- Periodicals; Hospital pharmacies -- Periodicals; 615.1
• DOI: 10.1136/ejhpharm-2012-000074.74
• Languages: English
• ISSNs: 2047-9956

Abstract

Abstract : Background: Antibacterial consumption has been associated with an increase in the growth of resistant bacterial strains. Hospital Pharmacists play an important role in antimicrobial stewardship strategies, by improving compliance with anti-infective prescribing recommendations. Purpose: To identify real-world situations in which pharmacists can intervene to improve antibacterial patterns of use in Hospital da Luz, Lisbon, Portugal. Materials and methods: Retrospective audit study. All courses of antibacterials for systemic use (therapeutic class J01), prescribed in patients over 18 years-old admitted to Hospital da Luz during January 2011, were extracted from the electronic medical records and analysed. Descriptive statistics were performed. Results: A total of 913 patients were admitted to hospital during the study period, being 81.1% (n=740) prescribed 961 antibacterial courses. Surgical prophylaxis represented 63.7% (n=612) of the courses. The following potential improvement areas were identified: ▶ In 4.9% (n=47) cases the reason for prescription was not identified. ▶ Prophylaxis duration was longer than 48 h in 2.1% and between 24 and 48 h in 10.8% courses. A clear distinction between antibacterials prescribed for prophylaxis and therapy was found, except for second-generation cephalosporins (78.3% vs 21.7%), quinolones (24.6% vs 75.4%), and imidazole derivatives (57.1% vs 42.9%). ▶ Only 3.8% (n=12) of the 349 non-surgical prophylactic and therapeutic antibacterial prescriptions were discontinued after microbiological identification and/or antibiotic susceptibility test results. Parenteral administration represented 73.9% (n=258) of these 349 courses, whereas only 8.4% (n=20) were discontinued due to intravenous-to-oral switch. Conclusions: After an indepth audit process, the following opportunities for pharmacists' interventions to improve the antibacterial pattern of use in our hospital were identified: unclear prescription indication, inappropriate extension of surgical prophylaxis duration, inappropriate selection of the prophylactic antibacterial agent, insufficient microbiological identification follow-up, and scarce intravenous-to-oral switch.