Pedro Mas-Morey1,2, Marta Valle2,3. 1. Department of Pharmacy, Hospital Quirónsalud Palmaplanas, Palma de Mallorca, Balearic Islands, Spain. 2. Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain. 3. Pharmacokinetic/Pharmacodynamic Modelling and Simulation, Sant Pau Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
Abstract
OBJECTIVE: Antimicrobial stewardship programmes (ASPs) have been widely implemented in large hospitals but little is known regarding small-to-medium-sized hospitals. This literature review evaluates outcomes described for ASPs participated in by clinical pharmacists and implemented in small-to-medium-sized hospitals (<500 beds). METHODS: Following PRISMA principles, PubMed and Cochrane Library databases were searched in early 2016 for English language articles describing implementation and outcomes for inpatient ASPs participated in by clinical pharmacists in small-to-medium-sized hospitals. Each included study was required to include at least one of the following outcomes: microbiological outcomes, quality of care and clinical outcomes or antimicrobial use and cost outcomes. RESULTS: We included 28 studies from 26 hospitals, mostly American or Canadian. Most cases (23 studies) consisted of time-series comparisons of pre-and post-intervention periods. Of the 28 studies analysed, 8 reported microbiological outcomes, 21 reported quality of care and clinical outcomes, and 27 reported antimicrobial use and cost outcomes. Interventions were not generally associated with significant changes in mortality or readmission rates but were associated with substantial cost savings, mainly due to reduced use of antibiotics or the use of cheaper antibiotics. CONCLUSION: As far as we are aware, ours is the first systematic review that evaluates ASPs participated in by clinical pharmacists in small-to-medium-sized hospitals. ASPs appear to be an effective strategy for reducing antimicrobial use and cost. However, the limited association with better microbiological, care quality and clinical outcomes would highlight the need for further studies and for standardised methods for evaluating ASP outcomes.
OBJECTIVE: Antimicrobial stewardship programmes (ASPs) have been widely implemented in large hospitals but little is known regarding small-to-medium-sized hospitals. This literature review evaluates outcomes described for ASPs participated in by clinical pharmacists and implemented in small-to-medium-sized hospitals (<500 beds). METHODS: Following PRISMA principles, PubMed and Cochrane Library databases were searched in early 2016 for English language articles describing implementation and outcomes for inpatient ASPs participated in by clinical pharmacists in small-to-medium-sized hospitals. Each included study was required to include at least one of the following outcomes: microbiological outcomes, quality of care and clinical outcomes or antimicrobial use and cost outcomes. RESULTS: We included 28 studies from 26 hospitals, mostly American or Canadian. Most cases (23 studies) consisted of time-series comparisons of pre-and post-intervention periods. Of the 28 studies analysed, 8 reported microbiological outcomes, 21 reported quality of care and clinical outcomes, and 27 reported antimicrobial use and cost outcomes. Interventions were not generally associated with significant changes in mortality or readmission rates but were associated with substantial cost savings, mainly due to reduced use of antibiotics or the use of cheaper antibiotics. CONCLUSION: As far as we are aware, ours is the first systematic review that evaluates ASPs participated in by clinical pharmacists in small-to-medium-sized hospitals. ASPs appear to be an effective strategy for reducing antimicrobial use and cost. However, the limited association with better microbiological, care quality and clinical outcomes would highlight the need for further studies and for standardised methods for evaluating ASP outcomes.
Entities:
Keywords:
clinical pharmacy; infectious diseases; pharmacotherapy; side effects of drugs; therapeutics
Authors: Timothy H Dellit; Robert C Owens; John E McGowan; Dale N Gerding; Robert A Weinstein; John P Burke; W Charles Huskins; David L Paterson; Neil O Fishman; Christopher F Carpenter; P J Brennan; Marianne Billeter; Thomas M Hooton Journal: Clin Infect Dis Date: 2006-12-13 Impact factor: 9.079
Authors: Fiona M MacKenzie; Ian M Gould; Julie Bruce; Jill Mollison; Dominique L Monnet; Vladimir Krcmery; Barry Cookson; Jos W M van der Meer Journal: J Hosp Infect Date: 2007-06 Impact factor: 3.926
Authors: M Masiá; C Matoses; S Padilla; A Murcia; V Sánchez; I Romero; A Navarro; I Hernández; F Gutiérrez Journal: Eur J Clin Microbiol Infect Dis Date: 2008-03-04 Impact factor: 3.267
Authors: Emma Pinet; P Sabatier; M P Fernandez-Gerlinger; A S Jannot; J L Mainardi; B Sabatier; T Caruba Journal: Eur J Clin Microbiol Infect Dis Date: 2022-06-25 Impact factor: 3.267
Authors: Roberta Crevelário de Melo; Bruna Carolina de Araújo; Maritsa Carla de Bortoli; Tereza Setsuko Toma Journal: Rev Panam Salud Publica Date: 2020-09-23
Authors: Katherine E Goodman; Emily L Heil; Kimberly C Claeys; Mary Banoub; Jacqueline T Bork Journal: Open Forum Infect Dis Date: 2022-06-10 Impact factor: 4.423