Background Inappropriate use of antibiotics has become a serious problem in the hospital setting. We implemented a stewardship programme in order to optimise antimicrobial treatment at our hospital.

Purpose

1. To analyse the contribution of an antibiotic pharmacist after the introduction of the antimicrobial stewardship programme.

2. To analyse the economic impact of pharmacists’ recommendations.

Material and methods An antibiotic pharmacist designed a protocol to optimise antibiotic treatment in agreement with infectiologists and microbiologists. The programme started running in December 2013.

On a daily basis, the pharmacist obtains a list of inpatients prescribed antibiotics from the computerised prescription order entry system and recovers information from the electronic health record. The pharmacist checks the following items: (1) conformity of empirical and targeted antimicrobial treatment to clinical practice guidelines; (2) local flora and culture results; (3) dose adjustment to the clinical situation; (4) appropriate duration and (5) route of administration. If treatments are susceptible to improvement, the pharmacist contacts physicians to propose recommendations. The recommendations are recorded in a database. Additionally, the financial impact is evaluated in antimicrobial or dose changes.

Results We analysed 2,250 prescriptions (32% of total) over a 10-month period. Physicians were contacted on 347 occasions; 96% related to antibiotics and 4% to antifungals. In 86% of the cases they agreed with the proposals. Reasons to act were: 36% administered for too long, 20% inappropriate antibiotic selected, 18% unadjusted dose, 14% inappropriate empirical treatment, and 11% unestablished sequential treatment.

Direct costs could be estimated in 32% of the antibiotic and antifungal recommendations, leading to net savings of €9,566 (49%) and €10,041 (51%).

Conclusion

1. The contribution of an antibiotic pharmacist, as part of an antibiotic stewardship programme, resulted in a reduction of excessively prolonged antimicrobial courses and improvements in accordance with culture results, dose to patient condition, adjustment of empirical treatment to recommendations, and selection of a suitable route for administration.

2. Interventions in antifungal treatment were associated with greater savings.

References and/or Acknowledgements No conflict of interest.