Antibiotic regimens tailored by clinical pharmacist supported by intensivist enhance rational use of antibiotics

ABSTRACT

Background

High antibiotics utility rates have been observed in surgical intensive care units (SICU). The present study was performed to evaluate the effect of engaging a clinical pharmacist in SICU on rational use of antibiotic treatment.

Methods

This retrospective quasi-experimental experiment involved 505 patients, over a period of one year, admitted to emergency department surgical/trauma ICU of a large tertiary care hospital. Before and during pharmacist participation periods of six months, 226 and 153 patients, respectively, are compared.

Results

Antibiotics consumption pattern changed with a decrease in total antibiotic consumption from 101.42 to 94.1 Defined Daily Dose/100 patients’ days after the clinical pharmacist participation, in addition to, a statistically significant rise (p = 0.001) in percentage of appropriateness of the prescribed antibiotic therapy from 72.1% to 86.3%. Time to control infection (days) was not statistically different (p = 0.825) in both periods. The average ICU days of stay was statistically significant longer (p = 0.046) during pharmacist attendance (4.42 ± 5.61) in comparison with period without pharmacist attendance (3.31 ± 3.66). The difference in ICU mortality rate was not statistically significance (p = 0.217). Cost per stay increased by 65% during pharmacist intervention period.

Conclusions

Antibiotic management with pharmacist participation as a part of multidisciplinary team with intensivist can promote rate of the appropriateness of the prescribed antibiotic therapy, lower utility of antibiotic consumption, but with a longer ICU stay, no mortality reduction, and higher expenses per stay.

Trial Registry

ClinicalTrials.gov: NCT04931914.

KEYWORDS:

• Intensive care unit
• antibiotics
• clinical pharmacist
• emergency department

Acknowledgment

We would like to thank the clinical pharmacists in our clinical pharmacy unit for their dedicated follow-up of our patients during the study.Gilan M. Ragab, Asmaa Salah, Nahla A.Sadik, Zahraa Ali.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Medical Ethics Committee of Alexandria University Hospitals (IRB NO:00012098) on 18th February; 2021.

Registry number

Clinical Trial Registry (NCT04931914) URL: https://clinicaltrials.gov/ct2/show/NCT04931914?term=NCT04931914&draw=2&rank=1

We wish to exclude this clinical trial registration from the similarity index.

Additional information

Funding

Self fund.