Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection

• Main Authors: Naoto Okada (Author), Momoyo Azuma (Author), Kaito Tsujinaka (Author), Akane Abe (Author), Mari Takahashi (Author), Yumiko Yano (Author), Masami Sato (Author), Takahiro Shibata (Author), Mitsuhiro Goda (Author), Keisuke Ishizawa (Author)
• Format: Book
• Published: MDPI AG, 2022-08-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.3390/antibiotics11091144; 2079-6382
• Keywords: antimicrobial stewardship; pharmacist; prospective audit with intervention and feedback; bloodstream infection; Therapeutics. Pharmacology; RM1-950
• Source: Antibiotics, Vol 11, Iss 9, p 1144 (2022)

Evidence for the utility of pharmacist-driven antimicrobial stewardship programs remains limited. This study aimed to evaluate the usefulness of our institutional pharmacist-driven prospective audit with intervention and feedback (PAF) on the treatment of patients with bloodstream infections (BSIs). The effect of pharmacist-driven PAF was estimated using an interrupted time series analysis with a quasi-experimental design. The proportion of de-escalation during BSI treatment increased by 44% after the implementation of pharmacist-driven PAF (95% CI: 30-58, <i>p</i> < 0.01). The number of days of therapy decreased by 16 per 100 patient days for carbapenem (95% CI: −28 to −3.5, <i>p</i> = 0.012) and by 15 per 100 patient days for tazobactam/piperacillin (95% CI: −26 to −4.9, <i>p</i> < 0.01). Moreover, the proportion of inappropriate treatment in empirical and definitive therapy was significantly reduced after the implementation of pharmacist-driven PAF. Although 30-day mortality did not change, compliance with evidenced-based bundles in the BSI of <i>Staphylococcus aureus</i> significantly increased (<i>p</i> < 0.01). In conclusion, our pharmacist-driven PAF increased the proportion of de-escalation and decreased the use of broad-spectrum antibiotics, as well as the proportion of inappropriate treatment in patients with BSI. This indicates that pharmacist-driven PAF is useful in improving the quality of antimicrobial treatment and reducing broad-spectrum antimicrobial use in the management of patients with BSI.