Background In our hospital the pharmacist has actively participated in a project ‘antimicrobial stewardship’ started in 2013 to improve the appropriateness of antibiotic therapy.
Purpose To evaluate the prescription appropriateness of the main antibiotic molecules and the consumption of antibiotics for the years 2013 and 2014.
Material and methods Our IRCCS is a hospital with 1200 beds with an internal computer prescriptive system from which were extracted the usage data of antibiotics.
In this way it was possible to evaluate:
the use of antibiotics (J01) in monotherapy and polytherapy on the total of patients admitted in the 2 years;
consumption data of antibiotics for the years 2013 and 2014 rationalised in therapeutic groups at the third level of ATC, expressed as DDD/year;
adherence to dose regimens especially for tigecycline (drug applicant loading dose) in the 2 years;
the appropriateness of prescribing major antibiotic molecules undergo monitoring through a systematic analysis of reasoned submissions. The type of therapy prescribed by clinicians (empirical or targeted) was evaluated. The data were crossed with the data of microbiological isolation recorded for each patient treated and hospitalised in 2014
Results More than half of hospitalised patients received an antibiotic (56.80% in 2013; 53.11% in 2014) and about one-third more than one antibiotic (33.60% in 2013; 30.28% in 2014); the trend was slightly downhill. Consumption of antibiotic expressed in DDD/year was significantly decreased for 2014 for the therapeutic subgroups J01C, J01D and J01M (respectively, 129 080, 92 108.17 and 88 506 in 2013 and 118 234; 78 290.18 and 70 770.54 in 2014. The appropriateness of administration of tigecycline improved by 11% in 2014.
Therapies were set in a focused way in 86% with colistin, 85% with tigecycline, 78% with ertapenem, 64% with daptomycin and 49% with linezolid. The correspondence of the antibiotic therapy with the microbiological data was appropriate in 90% with colistin, in 83% with ertapenem, in 80% with tigecycline, in 65% with daptomycin and in 32% with linezolid.
Conclusion The role of the pharmacist in the project allowed identification of the critical role of medical prescriptions and to create new pathways shared with infectivologists to preserve the last remaining antibiotic molecules.
References and/or Acknowledgements Antimicrobial resistance surveillance in Europe 2013.
No conflict of interest.
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