Abstract
Background: With the implementation of Antimicrobial Stewardship Program, clinical pharmacists’ consultation (CPC) for infectious diseases (ID) is gradually adopted by many hospitals in China. We conducted a cohort study to evaluate the effectiveness of CPC in ID treatment on patient outcomes and potential determinants.Methods: Based on a registry database, a prospective cohort study was conducted in Guizhou Provincial People’s Hospital. The main exposure factor was whether clinician adopted the suggestion from clinical pharmacist. The outcome was effective response rate (ERR) of ID patients. The variables associated with the outcome (e.g., age, gender, severity of infection, liver function, and kidney function) were also prospectively recorded. A multilevel model was performed to analyze the factors related to ERR.Results: A total of 733 ID inpatients were included in the final analysis according to the predesigned inclusion and exclusion criteria. The proportion of clinical pharmacists’ suggestions adopted by clinicians and ERR were 88.13 and 69.03%, respectively. Significant data aggregation (P < 0.05) for individuals at the level of department was observed. According to the two-level variance component model, liver dysfunction (Adjusted Odds Ratio (AOR) = 0.649, 95%Credible Interval (CI): 0.432–0.976), severity of infection (AOR = 0.602, 95%CI: 0.464–0.781), and adopting the suggestion from pharmacist (AOR = 1.738, 95%CI: 1.028–2.940) had significant association with ERR.Conclusion: Our study suggests that the effect of CPC on ID treatment is significant. The policy/decision makers or hospital managers should be cognizant of the critical value of clinical pharmacists in ID treatment.
Highlights
The severity of infectious diseases (ID) appears increasing due to the overflow of drug-resistant bacteria and abuse of antibiotics (Meek et al, 2015), and antimicrobial resistance (AMR) has become a serious global health challenge (Marston et al, 2016)
We designed a prospective cohort study basing on registry database, with which we explored important factors associated with patient outcome
A total of 1,292 patients were screened in the registry database, but only 733 patients meeting the inclusion criteria were included in the final analysis (Figure 1)
Summary
The severity of infectious diseases (ID) appears increasing due to the overflow of drug-resistant bacteria and abuse of antibiotics (Meek et al, 2015), and antimicrobial resistance (AMR) has become a serious global health challenge (Marston et al, 2016). A systematic review including 19 observational studies from 11 different countries indicated that Methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Acinetobacter baumannii (MRAB), and bacteria producing extended-spectrum β-lactamase (ESBL) costed $916.61–62908.00, $4644.00–98575.00, and $2824.14–30093.00 per person, respectively (Ling et al, 2017). A study indicated that the increase in AMR burden correlated with a 65% increase in human antimicrobial consumption between 2000 and 2015 in 76 countries (Klein et al, 2018). A report from China Antimicrobial Surveillance Network showed that, during 2005–2014, carbapenem-resistant rates of Klebsiella pneumoniae and A. baumannii had increased from 2.4 to 13.4% and 31 to 66.7%, respectively (Hu et al, 2016). We conducted a cohort study to evaluate the effectiveness of CPC in ID treatment on patient outcomes and potential determinants
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