Antimicrobial Stewardship for a Geriatric Behavioral Health Population.

Kristen Ellis,Victoria Chang,Nicolas Wong,Georgina Rubal-Peace,Eva Liang,Stephanie Campbell

doi:10.3390/antibiotics5010008

Kristen Ellis, Victoria Chang + Show 4 more

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https://doi.org/10.3390/antibiotics5010008

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Abstract

Antimicrobial resistance is a growing public health concern. Antimicrobial stewardship and multi-disciplinary intervention can prevent inappropriate antimicrobial use and improve patient care. Special populations, especially older adults and patients with mental health disorders, can be particularly in need of such intervention. The purpose of this project was to assess the impact of pharmacist intervention on appropriateness of antimicrobial prescribing on a geriatric psychiatric unit (GPU). Patients ≥18 years old prescribed oral antibiotics during GPU admission were included. Antimicrobial appropriateness was assessed pre- and post-pharmacist intervention. During the six-month pre- and post-intervention phase, 63 and 70 patients prescribed antibiotics were identified, respectively. Subjects in the post-intervention group had significantly less inappropriate doses for indication compared to the pre-intervention group (10.6% vs. 23.9%, p = 0.02), and significantly less antibiotics prescribed for an inappropriate duration (15.8% vs. 32.4%, p < 0.01). There were no significant differences for use of appropriate drug for indication or appropriate dose for renal function between groups. Significantly more patients in the post intervention group had medications prescribed with appropriate dose, duration, and indication (51% vs. 66%, p = 0.04). Pharmacist intervention was associated with decreased rates of inappropriate antimicrobial prescribing on a geriatric psychiatric unit.

Highlights

Adults over 65 years in age are much more likely to be taking multiple medications than younger adults, and are approximately seven times more likely to be hospitalized for an adverse drug reaction [1]
In an era in which antimicrobial drug resistance, adverse drug reactions, and Clostridium difficile infection (CDI) is increasingly prevalent, it is important for a multidisciplinary team to work together to tailor the most appropriate antibiotic regimen, especially for vulnerable populations
This project constitutes an example of a multi-disciplinary intervention strategy for improving antimicrobial prescribing in the absence of a formal antimicrobial stewardship program

Summary

Introduction

Adults over 65 years in age are much more likely to be taking multiple medications than younger adults, and are approximately seven times more likely to be hospitalized for an adverse drug reaction [1]. High rates of medication errors at hospital admission have been reported for patients with mental health disorders [2]. Antimicrobials are commonly prescribed inappropriately, and rising rates of antimicrobial resistance is a serious public health threat [3]. In an era in which antimicrobial drug resistance, adverse drug reactions, and CDI is increasingly prevalent, it is important for a multidisciplinary team to work together to tailor the most appropriate antibiotic regimen, especially for vulnerable populations. Pharmacists can be a valuable addition to the healthcare team and play an important role in ensuring antibiotic appropriateness. Murray et al conducted a prospective before-and-after study

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