Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin

Abstract

In 2018, a clinical decision support (CDS) tool was implemented as part of a “daily checklist” for frontline pharmacists to review patients on antibiotics with procalcitonin (PCT) <0.25 mcg/L. This study used a retrospective cohort design to assess change in antibiotic use from pharmacist interventions after this PCT alert in patients on antibiotics for lower respiratory tract infections (LRTI). The secondary outcome was antibiotic days of therapy (DOT), with a subgroup analysis examining antibiotic use and the length of stay (LOS) in patients with a pharmacist intervention. From 1/2019 to 11/2019, there were 165 alerts in 116 unique patients on antibiotics for LRTI. Pharmacists attempted interventions after 34 (20.6%) of these alerts, with narrowing spectrum or converting to oral being the most common interventions. Pharmacist interventions prevented 125 DOT in the hospital. Vancomycin was the most commonly discontinued antibiotic with an 85.3% use reduction in patients with interventions compared to a 27.4% discontinuation in patients without documented intervention (p = 0.0156). The LOS was similar in both groups (median 6.4 days vs. 7 days, p = 0.81). In conclusion, interventions driven by a CDS tool for pharmacist-driven antimicrobial stewardship in patients with a normal PCT resulted in fewer DOT and significantly higher rates of vancomycin discontinuation.

The role of the clinical pharmacist in antimicrobial stewardship in Asia: A review

“…A study in the United States showed that the use of procalcitonin levels to guide interventions by clinical pharmacists led to discontinuation of vancomycin therapy in patients with lower respiratory tract infections and normal procalcitonin levels. 53 Rapid identification of gram-positive bacteria through diagnostic systems like the VITEK-2 automated system, matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), and rapid polymerase chain reaction (PCR) with real-time ASP interventions by a clinical pharmacist have been implemented successfully in the United States. 19,20,54,55 Identification of antimicrobial susceptibility using Verigene along with ASP guidance can improve time to initiation of appropriate antimicrobials as well as reduce mortality rates and 30-day readmission rates.…”

Approaches to Reduce Use and Duration of Anti-MRSA Agents for Antimicrobial Stewardship Programs: A Review of Recent Literature

“…They suggest that prospective review and feedback and pre-prescription restrictions are 2 of the most effective actions and as such will be reviewed first. 23 Table 1 [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] summarized the actions employed and outcomes.…”

“…In the patients for whom interventions were made, one of the significant results was the discontinuation of vancomycin use (85.3% intervention vs 27.4% no intervention, P = .016). 43 The guideline usage to limit anti-MRSA therapy is not limited to adults. Lanata and colleagues added specific indications for empiric vancomycin use, incorporated in the PICU order set, to already occurring prospective review and feedback for bacterial community acquired infections.…”

“…In the patients for whom interventions were made, one of the significant results was the discontinuation of vancomycin use (85.3% intervention vs 27.4% no intervention, P = .016). 43…”

“…Summary of Studies Utilizing 1 Primary ASP Action and Impact on Anti-MRSA Therapy [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. …”