Abstract
BackgroundAntimicrobial resistance (AMR) is a serious global health threat and leads to a huge challenge to infectious diseases (ID) treatment. To tackle AMR, regional ‘Antimicrobial Stewardship Programs’ (ASP) have been implemented in many countries. Due to insufficient clinical pharmacy resources, a major intervention mode of ASP in China is through clinical pharmacist-led consultation (CPC). The current study aims to prospectively evaluate this intervention and compare the effectiveness of CPC served by ID and non-ID clinical pharmacists.MethodsWe conducted a prospective and multicenter cohort study based on a regional registry database in 17 hospitals in Western China, including consecutive patients with ID between April 2017 and December 2019. Baseline characteristics including sex, age, liver and kidney function, comorbidity, infection severity were prospectively collected and recorded. The main exposure of interest was whether the attending physician adopted recommendations of the clinical pharmacist in the therapeutic scheme. The outcome was the infection effective response, assessed during day 3–7 after completing CPC. Multivariate analyses were performed by generalized linear mixed models.ResultsA total of 2,663 ID patients were included in the final analysis according to the predesigned inclusion and exclusion criteria. The number of patients whose treatment followed and did not follow the pharmacists’ suggestion was 2,529 and 134, respectively. CPC intervention could improve the ID patient prognosis in the context of other confounders controlled (Adjusted Odds ratio(AOR)=1.838, 95%Confidence Interval(CI)=[1.212, 2.786]), and the effectiveness of CPC served by ID and non-ID clinical pharmacists might be equivalent (AOR=0.958, 95%CI[0.740, 1.240]). Special consultation (AOR=1.832, 95%CI[1.106, 3.035]) and surgical treatment of infectious sites (AOR=1.380, 95%CI[1.039, 1.834]) had positive influences on the patient prognosis, while hypoalbuminemia (AOR=0.694, 95%CI[0.523, 0.921]), liver dysfunction (AOR=0.705, 95%CI[0.559, 0.889]), presence of high-risk factors (AOR=0.775, 95%CI[0.613, 0.980]), and increased infection severity (AOR=0.631, 95%CI[0.529, 0.753])were associated with a decrease in effective response rate, independently.ConclusionThis study suggests that CPC is a promising pharmacist-led intervention to improve ID treatment, and it can achieve standardization among clinical pharmacists with different backgrounds by some measures. Policy/decision-makers should promote this intervention mode in developing countries or regions where there is an insufficient number of clinical pharmacists.
Highlights
Antimicrobial resistance (AMR) has become a serious global health challenge that can undo the decades of progress in declining morbidity and mortality from infectious diseases (ID) (Alsan et al, 2015; Marston et al, 2016; Thakur and Gray, 2019)
Antimicrobial Stewardship Program” (ASP) is instituted to promote the appropriate use of antimicrobials, improve patient outcome, reduce microbial resistance, and decrease the spread of infection caused by multidrug-resistant organisms (Charani et al, 2019)
As the clinicians did not apply for related examinations, information about hemogram, hypoalbuminemia, kidney function, liver function, and inflammatory indicator (C reactive protein, procalcitonin, or interleukin-6) were unavailable in 53 (1.99%), 439 (16.49%), 127 (4.77%), 117 (4.39%), 533 (20.02%) patients, respectively
Summary
Antimicrobial resistance (AMR) has become a serious global health challenge that can undo the decades of progress in declining morbidity and mortality from infectious diseases (ID) (Alsan et al, 2015; Marston et al, 2016; Thakur and Gray, 2019). ASP is instituted to promote the appropriate use of antimicrobials, improve patient outcome, reduce microbial resistance, and decrease the spread of infection caused by multidrug-resistant organisms (Charani et al, 2019). The inclusion of clinical pharmacists in ASP has been shown to result in significant improvement in terms of the quality of antibiotic use from various aspects, such as improving guidelineconcordant antimicrobial prescribing (Smith et al, 2018; Wang et al, 2018; Fay et al, 2019; Bishop et al, 2020), lessening the emergence of multidrug resistance (Li et al, 2017), shortening the days of antibiotic therapy (Wirtz et al, 2020), reducing the hospital stay of patients (Sadyrbaeva-Dolgova et al, 2020), and decreasing patients mortality (Li et al, 2017). The current study aims to prospectively evaluate this intervention and compare the effectiveness of CPC served by ID and non-ID clinical pharmacists
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
