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Role of the hospital pharmacist in an Italian antimicrobial stewardship programme
  1. Piera Polidori1,
  2. Daniele Leonardi Vinci2,
  3. Silvia Adami3,
  4. Stefano Bianchi4,
  5. Maria Ernestina Faggiano5,
  6. Alessio Provenzani1
  1. 1Clinical Pharmacy, ISMETT, Palermo, Italy
  2. 2School of Specialization in Hospital Pharmacy, University of Palermo, Palermo, Italy
  3. 3Pharmacy Service, AUSL Veneto, Verona, Veneto, Italy
  4. 4U.O. Hospital and Territorial Pharmaceutical Assistance, AUSL Ferrara, Ferrara, Emilia-Romagna, Italy
  5. 5Pharmacy, AOU Policlinico, Bari, Puglia, Italy
  1. Correspondence to Dr Piera Polidori, Clinical Pharmacy, ISMETT, Palermo, Italy; ppolidori{at}ismett.edu

Abstract

The inappropriate use of antimicrobial agents is contributing to an increasing phenomenon of bacterial resistance. For this reason, there is a growing interest in ‘antimicrobial stewardship’, a series of coordinated and multidisciplinary interventions aimed to promote the safe and appropriate use of antimicrobials in which the pharmacist’s contribution is necessary for the optimal choice of drug, dose, duration of therapy and the implementation of cost containment strategies.

Aim of the study We wanted to create a reference model and a specific training manual on antibiotic stewardship to introduce the role of the department pharmacist with specific infection disease skills in the Italian health system hospitals.

Methods This study was conducted in six Italian hospitals for 24 months. It was divided into three phases: definition of indicators (as defined daily doses/100 days of hospitalisation, switches from intravenous (IV) to oral and from empirical to targeted therapies, etc) elaboration of research protocol; sharing, application and detection of the indicators and selection of centres involved; analysis and sharing of results and subsequent drafting and distribution of the training manual.

Statistical analysis focused on possible differences between the frequencies of the aforementioned switches. Differences were analysed comparing the values recorded in the first quarter with those of the third quarter trough a χ² test. Statistical significance was set at p<0.05.

Results The pharmacist’s work showed a statistically significant increase in the conversion from IV to oral antibiotic therapy (χ² (1.496)=9112 ; p=0.0025; df=1). It was also detected a 5% improvement in appropriate dosing, 34% reduction in drug stocks, 4% increase in allergy reports and 275% increase in the number of adverse drug reactions reported.

Conclusions In this study, the interventions of the antibiotic stewardship pharmacist led to an improvement in quality of care, resource efficiency and healthcare professional awareness.

  • hospital pharmacy education
  • infection control
  • adverse effects
  • clinical pharmacy
  • quality in health care
  • infectious diseases
  • internal medicine
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