RESUMO
PURPOSE: Staphylococcus aureus is a leading cause of bacteremia with a 30-day mortality of 20%. This study evaluated outcomes after implementation of a pharmacist-driven Staphylococcus aureus bacteremia (SAB) initiative in a community hospital. METHODS: This retrospective cohort analysis compared patients admitted with SAB between May 2015 and April 2018 (intervention group) to those admitted between May 2012 and April 2015 (historical control group). Pharmacists were notified of and responded to blood cultures positive for Staphylococcus aureus by contacting provider(s) with a bundle of recommendations. Components of the SAB bundle included prompt source control, selection of appropriate intravenous antibiotics, appropriate duration of therapy, repeat blood cultures, echocardiography, and infectious diseases consult. Demographics (age, gender, and race) were collected at baseline. Primary outcome was in-hospital mortality. Compliance with bundle components was also assessed. RESULTS: Eighty-three patients in the control group and 110 patients in the intervention group were included in this study. Demographics were similar at baseline. In-hospital mortality was lower in the intervention group (3.6% vs. 15.7%; p = 0.0033). Bundle compliance was greater in the intervention group (69.1% vs. 39.8%; p < 0.0001). CONCLUSIONS: We observed a significant reduction in in-hospital mortality and increased treatment bundle compliance in the intervention cohort with implementation of a pharmacist-driven SAB initiative. Pharmacists' participation in the care of SAB patients in the form of recommending adherence to treatment bundle components drastically improved clinical outcomes. Widespread adoption and implementation of similar practice models at other institutions may reduce in-hospital mortality for this relatively common and life-threatening infection.
RESUMO
OBJECTIVE: Stewardship efforts within institutions are commonplace, but fewer programs exist in community health care settings. Existing efforts focus on improving appropriate prescribing; however, clinicians must consider the use of antibiotics without a prescription as a contributor to antibiotic resistance. The objective of this article is to report observed methods of antibiotic self-prescription within the United States. DATA SOURCES: A Medline search was conducted to identify stewardship efforts within the community health care setting. The authors visited nonpharmacy locations and performed Internet searches to assess the feasibility of acquiring antibiotics without a prescription. Nonpharmacy locations within Nashville, TN, were visited in 2016. SUMMARY: Published literature, patient interactions, experiences at markets and pet stores, and Internet searches confirmed the availability of antibiotics without a prescription. Thirteen antimicrobial agents were found locally, and 31 additional agents were available via Internet sources. Literature searches revealed a lack of any completed research specific to self-prescribing and acquisition of antibiotics in the community setting or its effect on antibiotic resistance. CONCLUSION: Combating antibiotic resistance in the community setting presents unique challenges. Further research is necessary to determine the impact of self-prescription on patients' outcomes. When designing a community stewardship program, patients' ability to self-prescribe antibiotics should be taken into account and addressed.
