Pharmacy intervention on antimicrobial management of critically ill patients / Intervención farmacéutica en el manejo antimicrobiano de pacientes críticamente enfermos

Frequent, suboptimal use of antimicrobial drugs has resulted in the emergence of microbial resistance, compromised clinical outcomes and increased costs, particularly in the intensive care unit (ICU). Mounting on these challenges is the paucity of new antimicrobial agents. Objectives: The study aims to determine the impact of prospective pharmacy-driven antimicrobial stewardship in the ICU on clinical and potential financial outcomes. The primary objectives were to determine the mean length of stay (LOS) and mortality rate in the ICU resulting from prospective pharmacy interventions on antimicrobial therapy. The secondary objective was to calculate the difference in total drug acquisition costs resulting from pharmacy infectious diseases (ID)-related interventions. Methods: In collaboration with an infectious disease physician, the ICU pharmacy team provided prospective audit with feedback to physicians on antimicrobial therapies of 70 patients over a 4- month period in a 31-bed ICU. In comparison with published data, LOS and mortality of pharmacymonitored ICU patients were recorded. Daily cost savings on antimicrobial drugs and charges for medication therapy management (MTM) services were added to calculate potential total cost savings. Pharmacy interventions focused on streamlining, dose optimization, intravenous-to-oral conversion, antimicrobial discontinuation, new recommendation and drug information consult. Antimicrobial education was featured in oral presentations and electronic newsletters for pharmacists and clinicians. Results: The mean LOS in the ICU was 6 days, which was lower than the published reports of LOS ranging from 11 to 36 days. The morality rate of 14% was comparable to the reported range of 6 to 20% in published literature. The total drug cost difference was a negative financial outcome or loss of USD192 associated with ID-related interventions. Conclusion: In collaboration with the infectious disease physician, prospective pharmacy intervention on antimicrobial therapy in the ICU led to positive clinical outcomes and an additional drug cost expense of USD192 (AU)

El frecuente uso sub-optimo de antimicrobianos ha producido la aparición de resistencias bacterianas, comprometido resultados clínicos e incrementado costes, particularmente en unidades de cuidados intensivos (UCI). Agregado a esto está ala escasez de nuevos agentes antimicrobianos. Objetivos: Este estudio trata de determinar el impacto de un control prospectivo de antimicrobianos realizado por farmacia en la UCI sobre los posibles resultados clínicos y financieros. Los objetivos primarios fueron determinar la duración de estancia media (LOS) y la tasa de mortalidad en la UCI como consecuencia de las intervenciones prospectivas de farmacia sobre el tratamiento antimicrobiano. El objetivo secundario fue calcular la diferencia total en costes de adquisición de medicamentos resultantes de las intervenciones farmacéuticas relacionadas con las enfermedades infeccionas. Métodos: En colaboración con un medico de enfermedades infecciosas, el equipo de farmacia de la UCI proporcionó auditoria prospectiva con retorno a los médicos sobre tratamientos antimicrobianos d 70 pacientes durante 4 meses en una UCI de 31 camas. En comparación con los datos publicados, se registró el LOS y la mortalidad de los de la UCI pacientes seguidos por farmacia. Para calcular el ahorro total posible, se sumó el ahorro en costes diarios en antimicrobianos a los costes de los servicios de manejo de la medicación (MTM). Las intervenciones farmacéuticas se centraron en aumento de eficiencia, optimización de dosis, conversión intravenosa a oral, iscontinuación, nuevas recomendaciones e información sobre medicamentos. La educación antimicrobiana se realizó en presentaciones orales y newsletters electrónicos para farmacéuticos y médicos. Resultados: La LOS media en la UCI fue de 6 días, que era menor de los informes publicados que oscilaban entre 11 y 36 días. La tasa de mortalidad del 14% al margen publicado en la literatura del 6 a 20%. La diferencia del coste total de medicamentos fue un resultado financiero negativo asociado a la intervención farmacéutica o pérdida de USD192. Conclusión: En colaboración con un médico infectólogo, la intervención prospectiva de la farmacia sobre el tratamiento antimicrobiano en la UCI condujo a resultados clínicos positivos y a un coste adicional de USD192 (AU)

Pharmacy intervention on antimicrobial management of critically ill patients.

UNLABELLED: Frequent, suboptimal use of antimicrobial drugs has resulted in the emergence of microbial resistance, compromised clinical outcomes and increased costs, particularly in the intensive care unit (ICU). Mounting on these challenges is the paucity of new antimicrobial agents. OBJECTIVE: The study aims to determine the impact of prospective pharmacy-driven antimicrobial stewardship in the ICU on clinical and potential financial outcomes. The primary objectives were to determine the mean length of stay (LOS) and mortality rate in the ICU resulting from prospective pharmacy interventions on antimicrobial therapy. The secondary objective was to calculate the difference in total drug acquisition costs resulting from pharmacy infectious diseases (ID)-related interventions. METHODS: In collaboration with an infectious disease physician, the ICU pharmacy team provided prospective audit with feedback to physicians on antimicrobial therapies of 70 patients over a 4-month period in a 31-bed ICU. In comparison with published data, LOS and mortality of pharmacy-monitored ICU patients were recorded. Daily cost savings on antimicrobial drugs and charges for medication therapy management (MTM) services were added to calculate potential total cost savings. Pharmacy interventions focused on streamlining, dose optimization, intravenous-to-oral conversion, antimicrobial discontinuation, new recommendation and drug information consult. Antimicrobial education was featured in oral presentations and electronic newsletters for pharmacists and clinicians. RESULTS: The mean LOS in the ICU was 6 days, which was lower than the published reports of LOS ranging from 11 to 36 days. The morality rate of 14% was comparable to the reported range of 6 to 20% in published literature. The total drug cost difference was a negative financial outcome or loss of USD192 associated with ID-related interventions. CONCLUSIONS: In collaboration with the infectious disease physician, prospective pharmacy intervention on antimicrobial therapy in the ICU led to positive clinical outcomes and an additional drug cost expense of USD192.