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Vol.38 No.4 contents | Japanese/English |
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Full Text of PDF (446K) Article in Japanese |
Evaluation of Changes in the Support System and Effectiveness of a Full-time Pharmacist Assigned to the Antimicrobial Stewardship Team in the Treatment of Infectious Diseases
Eiji HASHIMOTO1)2), Nobutaka CHIBA2)3), Junko SASAKI2) and Kazuo SHIMOGUCHI2)
1)Department of Pharmacy, Nihon University Hospital, 2)Department of Infection Control Room, Nihon University Hospital, 3)Department of Emergency and Critical Care Medicine, Nihon University Hospital
Since April 2018, the Antimicrobial Stewardship Team (AST) and full-time pharmacists have been assigned to the Nihon University Hospital. Particularly, we focused on daily monitoring of all antimicrobial agents for injection and blood culture results, de-escalation intervention, and appropriate use of antimicrobial agents in the perioperative period. We investigated these activities retrospectively over a 6-year period: 2 years before the intervention, 2 years in the initial period after the intervention (Phase I), and 2 years in collaboration with the pharmacist in charge of the hospital wards (Phase II). The number of antimicrobial therapy proposals decreased from 357 (adoption rate 86.8%) in Phase I to 167 (adoption rate 89.2%) in Phase II, due to the collaboration of ward pharmacists. Total antimicrobial consumption decreased in a stepwise fashion (median; 301.5 vs. 282.1 vs. 263.1, p < 0.001). We considered it to be an effect of the cephazolin intervention with low perioperative compliance. The de-escalation rate increased (pre; 73.3% vs. phase I; 90.3% vs. phase II; 89.8%, p < 0.001). This relationship was similar in patients with bacteremia (pre; 79.5% vs. stage I; 90.7% vs. stage II; 96.8%, p < 0.001). Conversely, there was no difference in 30-day mortality (pre; 8.4% vs. stage I; 5.2% vs. stage II; 3.9%, p = 0.180). The effect of the placement of a full-time pharmacist was to decrease the total antimicrobial consumption and increase the de-escalation rate. These results were maintained after collaboration with ward pharmacists.
Key words：antimicrobial stewardship team (AST), 30-day mortality rate, days of therapy (DOT), de-escalation rate
e-mail: hashimoto.eiji＠nihon-u.ac.jp
Received: June 24, 2022
Accepted: March 29, 2023
38 (4)：200─208,2023
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