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Impact of continuous pharmacist intervention for injectable antimicrobials on the treatment of patients with Escherichia coli bacteremia

Published:February 01, 2022DOI:https://doi.org/10.1016/j.ajic.2022.01.015

      Highlights

      • We examined the audit by pharmacists in whole antibiotics for E. coli bacteremia.
      • Antimicrobial use was reduced 29% by pharmacist intervention after three years.
      • Anti-pseudomonal drug use was reduced by 42% after three years intervention.
      • Pharmacists’ intervention was reduced costs by 24% without changing mortality.

      Abstract

      Background

      A prospective audit with intervention and feedback (PAF) by pharmacists is important for the appropriate use of antimicrobials. Clinically, Escherichia coli (E. coli) bacteremia is a common condition, but only few researchers have examined the role of PAF in its appropriate use of antimicrobials.

      Methods

      We started PAF by pharmacists in 2017 for all injectable antibiotics. This study included cases of E. coli bacteremia that resulted in hospitalization over a 4 year period from 2016 to 2019. Patients were grouped by year (Period 0–3), and clinical outcomes were examined.

      Results

      The pharmacists had 12 and 54 suggestions in Periods 0 and 3, respectively. The most common suggestion was de-escalation. The median duration of antimicrobial use was 12 (interquartile range: 8–15) days in Periods 0–2. The duration of antimicrobial use was significantly reduced to 9 (7–12) days in Period 3. In Period 3, the duration of antimicrobial use was reduced by 29%, while anti-pseudomonal drug use was reduced by 42% compared with that in period 0. The 30 day mortality rates were not significantly different between the groups.

      Conclusions

      PAF by pharmacists promotes the appropriate use of antimicrobials in patients with E. coli bacteremia; it is important to continue the program for several years.
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