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Clinical outcome of pharmacist-led prospective audit with intervention and feedback after expansion from patients using specific antibiotics to those using whole injectable antibiotics

  • Kengo OhashiEmail author
  • Tomoko Matsuoka
  • Yasutaka Shinoda
  • Takayuki Mori
  • Shinya Yoshida
  • Tomoaki Yoshimura
  • Tadashi Sugiyama
Original Article

Abstract

Prospective audit with intervention and feedback (PAF) and preauthorisation of antimicrobials are core strategies for antimicrobial stewardship (AS). PAF participants were expanded from patients using specific antibiotics to those using whole injectable antibiotics to evaluate clinical outcome. From January 2016 to December 2016, PAF was performed in patients using specific antibiotics (period 1) and from January 2017 to December 2017, PAF was performed in patients using whole injectable antibiotics (period 2). PAF was implemented for 5 days every week by pharmacists involved in infectious diseases chemotherapy. In total, 11,571 and 11,103 patients used antibiotic injections during periods 1 and 2, respectively. No significant difference in mortality within 30 days from the initial use of injection antibiotics was observed. The average duration of hospitalisation was significantly shorter during period 2 among patients using antibiotics; however, this was not significantly different from that of patients not receiving antibiotics. The average duration of therapy for intravenous antibiotics was significantly shorter during period 2 than during period 1. The ratio of methicillin-resistant Staphylococcus aureus (MRSA) to S. aureus was significantly low during period 2. The duration of intravenous antibiotic therapy for Escherichia coli bacteraemia during period 2 decreased significantly. De-escalation and appropriate antimicrobial treatment rates at specific doses during period 2 increased significantly. Expansion of patients eligible for PAF from patients using specific antibiotics to patients using whole injectable antibiotics shortened hospital stays, suppressed drug resistance, and promoted the appropriate use of antibiotics.

Keywords

Antimicrobial stewardship Antimicrobial resistance Prospective audit with intervention and feedback Pharmacist Intervention Japan 

Notes

Acknowledgements

We are grateful to all those who contributed to the antimicrobial stewardship program in our hospital.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Ethics Committee of Ogaki Municipal Hospital (Approval number: 20180628-2).

Informed consent

We disclosed this research and opted out.

References

  1. 1.
    Giske CG, Monnet DL, Cars O, Carmeli Y (2008) Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother 52:813–821CrossRefGoogle Scholar
  2. 2.
    Holmes AH, Moore LSP, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, Guerin PJ, Piddock LJ (2016) Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 387:176–187CrossRefGoogle Scholar
  3. 3.
    Niki Y (2017) Guidance for implementing an antimicrobial stewardship program Japan. Jpn J Chemother 65:650–687Google Scholar
  4. 4.
    Barlam TF, Cosgrove SE, Abbo LM, Macdougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK (2016) Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 62:e51–e77CrossRefGoogle Scholar
  5. 5.
    Johannsson B, Beekmann SE, Srinivasan A, Hersh AL, Laxminarayan R, Polgreen PM (2011) Improving antimicrobial stewardship the evolution of programmatic strategies and barriers. Infect Control Hosp Epidemiol 32:367–374CrossRefGoogle Scholar
  6. 6.
    Fukuda T, Watanabe H, Ido S, Shiragami M (2014) Contribution of antimicrobial stewardship programs to reduction of antimicrobial therapy costs in community hospital with 429 beds --before-after comparative two-year trial in Japan. J Pharm Policy Pract 7:10CrossRefGoogle Scholar
  7. 7.
    Murakami M, Komatsu H, Sugiyama M, Ichikawa Y, Ide K, Tsuchiya R, Kunieda K, Magishi A, Akiyama G, Miura F, Okada K, Ikezoe M (2018) Antimicrobial stewardship without infectious disease physician for patients with candidemia: a before and after study. J Gen Fam Med 19:82–89CrossRefGoogle Scholar
  8. 8.
    Kimura T, Uda A, Sakaue T, Yamashita K, Nishioka T, Nishimura S, Ebisawa K, Nagata M, Ohji G, Nakamura T, Koike C, Kusuki M, Ioroi T, Mukai A, Abe Y, Yoshida H, Hirai M, Arakawa S, Yano I, Iwata K, Tokimatsu I (2018) Long-term efficacy of comprehensive multidisciplinary antibiotic stewardship programs centered on weekly prospective audit and feedback. Infection 46:215–224CrossRefGoogle Scholar
  9. 9.
    Horikoshi Y, Suwa J, Higuchi H, Kaneko T, Furuichi M, Aizawa Y, Fukuoka K, Okazaki K, Ito K, Shoji T (2017) Sustained pediatric antimicrobial stewardship program with consultation to infectious diseases reduced carbapenem resistance and infection-related mortality. Int J Infect Dis 64:69–73CrossRefGoogle Scholar
  10. 10.
    Sakeena MHF, Bennett AA, McLachlan AJ (2018) Enhancing pharmacists’ role in developing countries to overcome the challenge of antimicrobial resistance: a narrative review. Antimicrob Resist Infect Control 7:63CrossRefGoogle Scholar
  11. 11.
    Matsuoka T, Kato M, Shinoda Y, Ohashi K, Yoshida S, Mori T, Tachi T, Yoshimura T, Teramachi H (2017) Evaluation of antimicrobial stewardship (AS) for appropriate use of antimicrobial agents. Pharmazie 72:296–299Google Scholar
  12. 12.
    Ohashi K, Matsuoka T, Shinoda Y, Yoshida S, Arai K, Kato M, Mori T, Yoshimura T (2017) Effectiveness of a computer-facilitated, pharmacist-driven antimicrobial stewardship program for infection management. Yakugaku Zasshi 137:643–650CrossRefGoogle Scholar
  13. 13.
    Government of Japan (2016) National Action Plan on antimicrobial resistance (AMR). The Government of Japan;2016–20Google Scholar
  14. 14.
    Chow JW, Yu VL (1999) Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: a commentary. Int J Antimicrob Agents 11:7–12CrossRefGoogle Scholar
  15. 15.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  16. 16.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41CrossRefGoogle Scholar
  17. 17.
    Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, Reller LB, Sexton DJ (2002) Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 137:791–797CrossRefGoogle Scholar
  18. 18.
    The Japanese association for infectious diseases, Japanese Society of Chemotherapy. The JAID/JSC guide to clinical management of infectious diseases 2014Google Scholar
  19. 19.
    Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458CrossRefGoogle Scholar
  20. 20.
    Ohashi K, Shinoda Y, Matsuoka T, Yoshida S, Mori T, Hayashi H et al (2018) Evaluation of a prospective audit and feedback intervention by pharmacists for patients receiving intravenous antibiotics. Jpn J Pharm Health Care Sci 44:305–312Google Scholar
  21. 21.
    Niwa T, Shinoda Y, Suzuki A, Ohmori T, Yasuda M, Ohta H, Fukao A, Kitaichi K, Matsuura K, Sugiyama T, Murakami N, Itoh Y (2012) Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital. Int J Clin Pract 66:999–1008CrossRefGoogle Scholar
  22. 22.
    Dunn K, O’Reilly A, Silke B, Rogers T, Bergin C (2011) Implementing a pharmacist-led sequential antimicrobial therapy strategy: a controlled before-and-after study. Int J Clin Pharm 33:208–214CrossRefGoogle Scholar
  23. 23.
    Macheda G, Dyar OJ, Luc A, Beovic B, Béraud G, Castan B, Gauzit R, Lesprit P, Tattevin P, Thilly N, Pulcini C (2018) ESGAP and SPILF. Are infection specialists recommending short antibiotic treatment durations? An ESCMID international cross-sectional survey. J Antimicrob Chemother 73:1084–1090CrossRefGoogle Scholar
  24. 24.
    Shen J, Sun Q, Zhou X, Wei Y, Qi Y, Zhu J, Yan T (2011) Pharmacist interventions on antibiotic use in inpatients with respiratory tract infections in a Chinese hospital. Int J Clin Pharm 33:929–933CrossRefGoogle Scholar
  25. 25.
    Lawes T, Lopez-Lozano JM, Nebot CA, Macartney G, Subbarao-Sharma R, Dare CR, Wares KD, Gould IM (2015) Effects of national antibiotic stewardship and infection control strategies on hospital-associated and community-associated meticillin-resistant Staphylococcus aureus infections across a region of Scotland: a non-linear time-series study. Lancet Infect Dis 15:1438–1449CrossRefGoogle Scholar
  26. 26.
    Ohashi K, Matsuoka T, Shinoda Y, Fukami Y, Shindoh J, Yagi T, Yoshimura T, Sugiyama T (2018) Evaluation of treatment outcomes of patients with MRSA bacteremia following antimicrobial stewardship programs with pharmacist intervention. Int J Clin Pract 72:e13065CrossRefGoogle Scholar
  27. 27.
    Howard P, Pulcini C, Levy Hara G, West RM, Gould IM, Harbarth S, Nathwani D (2014) ESCMID Study Group for Antimicrobial Policies (ESGAP); ISC Group on Antimicrobial Stewardship. An international cross-sectional survey of antimicrobial stewardship programmes in hospitals. J Antimicrob Chemother 70:1245–1255Google Scholar
  28. 28.
    Wintenberger C, Guery B, Bonnet E, Castan B, Cohen R, Diamantis S, Lesprit P, Maulin L, Péan Y, Peju E, Piroth L, Stahl JP, Strady C, Varon E, Vuotto F, Gauzit R (2017) Recommendation group of the SPILF. Proposal for shorter antibiotic therapies. Med Mal Infect 47:92–141CrossRefGoogle Scholar
  29. 29.
    Doi A, Morimoto T, Iwata K (2018) Shorter duration of antibiotic treatment for acute bacteraemic cholangitis with successful biliary drainage: a retrospective cohort study. Clin Microbiol Infect 24:1184–1189CrossRefGoogle Scholar
  30. 30.
    Nelson AN, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN (2017) Optimal duration of antimicrobial therapy for uncomplicated Gram-negative bloodstream infections. Infection 45:613–620CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PharmacyOgaki Municipal HospitalOgaki-cityJapan
  2. 2.Laboratory of Pharmacy Practice and Social ScienceGifu Pharmaceutical UniversityGifuJapan

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