Antibiotic Stewardship without an Antibiotic Stewardship Program?

Abstract

To promote heightened vigilance concerning antibiotic agents in Canadian hospitals, Accreditation Canada has implemented antibiotic stewardship as a required organizational practice.1 Antibiotic stewardship is the process of ensuring that only necessary and appropriate antibiotic agents are used and that their use is appropriate for each individual patient. It involves optimizing all steps of antibiotic therapy, including appropriate selection, dosing, route, and duration. Through antibiotic stewardship strategies, a hospital can optimize the use of antibiotics, reduce the risk of opportunistic infections, stabilize or reduce antibiotic resistance, promote patient safety, and reduce health care costs.1,2 According to the American Society of HealthSystem Pharmacists, pharmacists have the ability, while providing care to individual patients, to effectively participate in antibiotic stewardship through their activities as members of health care teams and committees and by using their knowledge and abilities to focus on proper antibiotic utilization.3,4 The current study was conducted within the Providence Health Care health authority, which comprised 2 acute care hospitals and several residential facilities in the lower mainland of British Columbia. In this health authority, pharmacistinitiated antibiotic stewardship practices have been in place for many years, despite the absence of a formal antibiotic stewardship program. No pharmacists or physicians were specifically assigned responsibility for ensuring that antibiotic use was appropriate for admitted patients. However, pharmacists at Providence Health Care were involved on a day-to-day basis in pharmaceutical care related to all aspects of drug therapy for admitted patients, including antibiotic therapy. In the course of providing care, pharmacists frequently performed antibiotic stewardship activities, such as making recommendations to narrow the spectrum of activity of prescribed therapy, adjusting dosages, stepping down from parenteral to oral therapy, stopping unnecessary antibiotics, and switching to more appropriate antibiotics. The Antibiotic Subcommittee of the health authority’s Pharmacy and Therapeutics Committee had established restrictions, procedures, and recommendations regarding the use of antibiotic agents. The Pharmacy Department had an expectation that all pharmacists would perform activities appropriate for ensuring the optimal use of antibiotic agents. The purpose of this study was to quantify the antibiotic stewardship activities performed by pharmacists at Providence Health Care before implementation of a formal anti biotic stewardship program. A literature search identified no studies quantifying antibiotic stewardship activities performed by pharmacists in any Canadian hospital. The primary objective of the study was to quantify the various potential antibiotic stewardship activities related to target broad-spectrum antibiotics at St Paul’s Hospital and Mount Saint Joseph Hospital, the 2 acute care hospitals within Providence Health Care. The primary outcome was the proportion of patients included in the review who received the target antibiotics and experienced at least one antibiotic stewardship intervention by a pharmacist. The secondary objective was to determine the frequency of each type of antibiotic stewardship intervention.