Antibiotic Use Evaluation ： An Analysis of Clinical Pharmacy Service in an Intensive Care Unit
英文摘要
Background: Optimized antibiotic therapy is an important issue in clinical pharmacy service. There is a continuing trend of increase in intensive care unit (ICU)-acquired nosocomial infections and related multiple-drug resistant
microorganisms resulting in higher morbidity and mortality, prolonged the duration of hospital stays and higher medical costs. Optimized antibiotic therapy may reduce antibiotic cost and the implantation of patient-centered clinical pharmacy service in the intensive care unit which in turn may improve quality of care, reduce inappropriate uses of antibiotics and save medical costs.
Objective: The research objective was to evaluate whether the intervention of clinical pharmacy service in an intensive care unit could reduce the inappropriate use of antibiotics. The main foci of the evaluation of medication management were optimal use of antibiotics related to dosage, courses, costs and acceptance of the pharmacist recommendations by physicians and to assess the impact of clinical pharmacy intervention on patients’ outcomes.
Methods: This prospective observational study investigated the incidence of ICU- acquired nosocomial infections, clinical epidemiology, and antibiotic uses for patients stayed in the 20 ICU beds during the period from June 2008 to May 2009.
Patients who stayed in the ICU for less than 24 hours were excluded from the study. With the permission of IRB board, data collection included age, gender, body height, body weight, body mean index, renal function, the length of ICU stay, APACHE II score, initial type of infections, initial site of infections, pathogens, antibiotics, dosage, duration, costs, interventions, acceptance of physicians, ICU- acquired nosocomial infections, and patients’ outcomes. Data analysis was conducted by SPSS (Statistic Package for Social Science, version 15.0 for windows).
Results: During the research period there were 528 patients included in the study.
Kaplan-Meier survival analysis revealed ICU-acquired nosocomial infection occurred most frequently during day 10-13 (E= 11.7, 95% CI: 10.54 – 12.86) and the incidence rate was 15.91%. There were no significant differences between ICU-acquired nosocomial infection group and non-infected group regarding baseline demographic properties. When compared with non-infected group (n=
444), patients with ICU-acquired nosocomial infection (n= 84) revealed prolonged length of ICU stay (21 days vs. 9 days, p< 0.05) and higher risk for mortality (OR=
2.95, 95% CI: 1.62-5.36, p< 0.05). Successful intervention by pharmacist did not increase ICU-acquired nosocomial infection (OR= 0.57, 95% CI: 0.29-1.12,
p=0.102, n=528), the length of ICU stay (21.82 ± 7.18 days vs. 21.13 ± 8.97 days, p= 0.702, n=84) and mortality (OR: 0.97, 95% CI: 0.22-4.23, p= 0.966, n=84). Beside, before ICU-acquired nosocomial infection, successful pharmacist intervention was associated with lower antibiotic daily cost (B= -0.092, p= 0.038).
Total net cost savings was NTD 277,982 per annum and the benefit-to-cost ratio was 3.27:1 for antibiotic use of clinical pharmacy interventions.
Conclusions: This study revealed a significant correlation between the
development of ICU-acquired nosocomial infection and extended length of ICU stay and mortality. Successful clinical pharmacy interventions relating to antibiotic therapy lowered costs without compromising patients’ clinical outcomes such as ICU-acquired nosocomial infection, the length of ICU stay and mortality. Clinical pharmacy interventions in antibiotic use contributed to improve economic outcome of patient in ICU
