Impact of a Multifaceted Pharmacist-Led Intervention on Antimicrobial Stewardship in a Gastroenterology Ward: A Segmented Regression Analysis

Abstract

Background: Irrational use of antimicrobial agents for gastrointestinal diseases deserves attention, but corresponding antimicrobial stewardship programs (ASPs) are generally not a priority for managers. We conducted this study to evaluate the effectiveness of multifaceted pharmacist-led (MPL) interventions in the gastroenterology ward (GW) to provide evidence for the efficacy of ASPs in a non-priority department. Methods: This was an interventional, retrospective study implemented in China. The MPL intervention lasting 1.5 years involved daily ward rounds with physicians, regular review of medical orders, monthly indicator feedback, frequent physician training, and necessary patient education. Data on all hospitalized adults receiving antibiotics was extracted from the hospital information system over a 36-month period from January 2016 to December 2018. Segmented regression analysis of interrupted time series was performed to evaluate the effect of the MPL interventions (started in July 2017) on antibiotic use and length of hospital stay, which was calculated monthly as analytical units. Results: A total of 1763 patients receiving antibiotics were enrolled. Segmented regression models showed descending trends from the baseline in the intensity of antibiotic consumption (coefficient = −0.88, p = 0.01), including a significant decline in the level of change of the proportion of patients receiving combined antibiotics (coefficient = −9.91, p = 0.03) and average length of hospital stay (coefficient = −1.79, p = 0.00), after MPL interventions. The MPL interventions led to a temporary increase in the proportion of patients receiving antibiotics (coefficient = 4.95, p = 0.038), but this was part of a declining secular trend (coefficient = −0.45, p = 0.05). Conclusion: The MPL interventions led a statistically significant decline in the number of patients receiving antibiotics, the antibiotic consumption, and the average hospital stay post-intervention compared to the pre-intervention phase of the study. Health

The impact of pharmacist-led antimicrobial stewardship program on antibiotic use in a county-level tertiary general hospital in China: A retrospective study using difference-in-differences design

“…Second, as an important part of the antimicrobial stewardship team, microbiologists are responsible for cumulative antimicrobial susceptibility tests for the accuracy of antibiotics, and the shortened duration of empirical treatment due to clear microbiological results was a driver for cost saving. Third, the indicator of the average LOS in this study decreased after the ASPs intervention in the hepatobiliary surgery ward, which was similar to another study in the gastroenterology ward ( 18 ). Besides, LOS was a vital influencing factor for hospitalization costs.…”

“…Nevertheless, physicians have a different thinking process that they would attach more importance to the effects of antibiotics than the spread of resistance in empirical use ( 24 ), which results in the overuse of broad-spectrum antibiotics such as meropenem and biapenem. Meanwhile, the concerns of physicians about the failure of the treatment can also lead to the excessive use of broad-spectrum antibiotics for surgical prophylaxis and frequent switching and combination of antibiotics ( 18 ). It is common for some patients without proper indications to require prescriptions for antibiotics ( 25 ).…”

Standard of practice in infectious diseases for pharmacy services

“…Pharmacists are continuing to show their expertise in specific subspecialty areas within AMS, including antifungal stewardship, 26 and antimicrobial allergy de‐labelling 27,28 . Published evidence abroad is consistent with the Australian experience and further supports these findings 5,29‐31 …”

The Impact of a Multifaceted Pharmacist-Led Antimicrobial Stewardship Program on Antibiotic Use: Evidence From a Quasi-Experimental Study in the Department of Vascular and Interventional Radiology in a Chinese Tertiary Hospital

“…Several studies provided evidence that pharmacist-led interventions can improve adherence to guidelines and reduced the duration of antimicrobial therapy with substantial cost savings for patients ( Mahmoudi et al, 2019 ; Monmaturapoj et al, 2021 ). Furthermore, implementation of pharmacy-based interventions in AMS programs can reduce antibiotic consumption, length of hospital day, and 30-day mortality ( Xin et al, 2019 ; Du et al, 2020 ).…”