Category: Professional Posters
Purpose: An antimicrobial stewardship program (AMS) has been implemented globally to combat the misuse or overuse of antimicrobials which is well known cause of antimicrobial resistance and antimicrobial related adverse events. Although specialized pharmacists have been proposed as essential member of AMS in several authoritative guidelines, many, but not all hospitals in Korea operate AMS without involvement of pharmacists due to shortage of hospital pharmacists. Therefore, we aimed to evaluate the association of active participation of clinical pharmacist as a team member of multidisciplinary AMS with the incidence of antimicrobial related adverse events.
Methods: Five tertiary teaching hospitals participated in this retrospective cohort study. We classified hospitals as AMS with pharmacist or AMS without pharmacist group according to the involvement of clinical pharmacist in AMS. Patients who used systemic antimicrobial agents more than one day during the first quarter of 2017 were identified. Among them, 1,000 patients were randomly selected from each participating hospital. Systemic antimicrobials included antibacterials (J01), antimycotics (J02) and antivirals for systematic use (J05AA, J05AB, J05AC, J05AD, J05AH). We excluded antituberculosis drugs, antiviral agents for hepatitis and HIV. The incidence of five categories of antimicrobial related adverse events were determined; allergic reaction, hematologic toxicities, nephrotoxicity, hepatotoxicity, and antimicrobial associated diarrhea including C.difficile associated diarrhea (CDAD). Multivariate logistic regression analysis was used to evaluate the impact of pharmacist involvement in AMS on the incidence of adverse drug events (ADEs).
Results: In total, 4,995 patients were included for the analysis after excluding 5 patients due to incomplete laboratory data. A total of 1,195 antimicrobial related ADEs occurred in 618 patients (12.4%). The overall rate of ADE occurrence was 17.4 per 1,000 patient-days. Hospitals operating AMS with pharmacist had significantly lower ADE incidence proportion than the others (8.9% vs. 14.7%, p < 0.001). Rates of ADE occurrence per 1,000 patient-days were 15.1 and 18.3 in hospitals with and without AMS pharmacist, respectively (p=0.003). Multivariate logistic analysis showed that active pharmacist involvement in AMS reduced the risk of antibiotic associated adverse reactions by 38% (adjusted odds ratio 0.62, 95% confidence interval, 0.50-0.76).
Conclusion: The results of this study suggest that the active involvement of clinical pharmacists in the multidisciplinary AMS can reduce the incidence of antimicrobial related adverse events in hospitalized patients. Therefore, a system should be introduced where infectious diseases clinical pharmacy specialist can play an active role in multidisciplinary AMS of the hospital to reduce the antibiotic related adverse reactions.