[Antimicrobial Stewardship and Education, the Role of Pharmacists in the University Hospital].

Over the last decade, many public institutions have emphasized the importance of antimicrobial stewardship (AS) in reducing the spread of antimicrobial resistance. In our facility, we have tackled AS that has adapted to clinical practices since 2015. In many facilities, especially university hospitals, multidrug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus and extended-spectrum ß-lactamase-producing bacteria, may cause infections. Considering this, we recommend prompt treatment with suitable antibiotics and dosage. In AS teams, pharmacists are responsible for administering pharmacotherapy, including optimal dosage for each patient. Therefore, they should assess their patients carefully, implement thorough therapeutic drug monitoring, and utilize the information obtained from these assessments to administer optimal pharmacotherapy. However, optimal pharmacotherapy also requires a correct diagnosis. Although diagnostic stewardship is not a pharmacist's work, it is a great opportunity for pharmacists to learn how expert physicians think. Based on the type of situation above, we train younger pharmacists on the job.

The incidence of endophthalmitis or macular involvement and the necessity of a routine ophthalmic examination in patients with candidemia.

BACKGROUND: The incidence of ocular candidiasis (OC) in patients with candidemia varies across different reports, and the issue of whether routine ophthalmoscopy improves outcomes has been raised. This study investigated the incidence of OC and evaluate whether the extent of OC impacts the clinical outcomes. METHODS: This retrospective study included non-neutropenic patients with candidemia who underwent treatment at one of 15 medical centers between 2010 and 2016. Chorioretinitis without other possible causes for the ocular lesions and endophthalmitis was classified as a probable OC. If signs of chorioretinitis were observed in patients with a systemic disease that causes similar ocular lesions, they were classified as a possible OC. RESULTS: In total, 781 of 1089 patients with candidemia underwent an ophthalmic examination. The prevalence of OC was 19.5%. The time from the collection of a positive blood culture to the initial ophthalmic examination was 5.0 ± 3.9 days in patients with OC. The leading isolate was Candida albicans (77.9%). Possible OC was associated with unsuccessful treatments (resolution of ocular findings) (odds ratio: 0.354, 95% confidence interval: 0.141-0.887), indicating an overdiagnosis in patients with a possible OC. If these patients were excluded, the incidence fell to 12.8%. Endophthalmitis and/or macular involvement, both of which require aggressive therapy, were detected in 43.1% of patients; a significantly higher incidence of visual symptoms was observed in these patients. CONCLUSION: Even when early routine ophthalmic examinations were performed, a high incidence of advanced ocular lesions was observed. These results suggest that routine ophthalmic examinations are still warranted in patients with candidemia.