Background The use (and misuse) of antibiotics not only influences therapeutic outcomes for the individual patient, but due to emerging resistance, the whole population may also be affected. Advocating a multidisciplinary approach, including pharmacists, has the potential to achieve better clinical outcomes and rationalised antibiotic consumption.
Purpose To assess the potential benefit of the recent implementation of clinical pharmacy services in an intensive care unit (ICU) by analysing the usage pattern of antibiotics prescribed by a multiprofessional team.
Material and methods The study was conducted in a 12 bed ICU from 01 September 2016 to 15 October 2016. Antibiotic medication review was carried out by clinical pharmacists using a worksheet approved by the local drug and therapeutic committee. It contained data about the patient’s identity, admission parameters, length of stay, duration of mechanical ventilation, prescribed antibiotics, microbial cultures and SOFA scores.
Results 42 patients were screened, 18 of whom were older than 65 years. Length of treatment was longer than 7 days in 11 patients. 21 subjects were mechanically ventilated, 12 of whom were on ventilation for 1–4 days, while the others were ventilated for more than 5 days. 6 patients contracted a nosocomial infection which was associated with longer mechanical ventilation.
9 patients died, 14 were transferred to sub-intensive care and 19 were transferred to other departments. 18 received postoperative prophylactic antibiotic therapy, and 1 case was not in line with current guidelines. In 26 cases, empirical antibiotic regimens were issued, while only 8 patients were treated with targeted therapies. 34 subjects received one or two antibiotics, and in 11 cases, a change in the therapeutic regimen was issued due to insufficient therapeutic response. Unfortunately, de-escalation was implemented in only 6 cases, the rate of which might presumably be increased by the recent introduction of a clinical pharmacist to the ICU. The low de-escalation rate was rationalised by a highly cautious attitude of intensive care physicians.
Conclusion The attributable medical and population wide costs of antimicrobial therapies are sizable. Results from this assessment might provide an argument for the potential need of a multiprofessional approach when prescribing antimicrobial therapies in the ICU, especially for mechanically ventilated patients.
No conflict of interest
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