Targeting antimicrobial restriction: outcomes of pharmacist-led stewardship interventions at the university hospital Salzburg.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-07-09 DOI:10.1007/s15010-025-02604-x

Eva Past, Laura Hartmann, Robert Zimmermann, Georg Zimmermann, Markus Wallner, Lisa Walter, Ulrike Porsche, Jan Marco Kern

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引用次数: 0

Abstract

Purpose: Antimicrobial overuse and misuse remain critical challenges. This study examined pharmacist-led post-prescription interventions targeting restricted antimicrobials in a university hospital, identifying underlying drug-related problems (DRPs), their clinical relevance, economic impact and characteristic patterns of inappropriate use.

Methods: A retrospective observational analysis (January- December 2022) was conducted at the Salzburg State Hospitals using routine data of pharmacist-led interventions on restricted antimicrobials. DRPs and intervention types were categorized using validated criteria. Clinical relevance was independently assessed through an external survey, and interrater reliability was determined to ensure consistency in classification and evaluation. Potential cost savings and acceptance rates of the pharmaceutical interventions were assessed.

Results: A total of 3897 restricted antimicrobial prescriptions were analyzed, with 11.7% (456) showing at least one DRP in 366 patients. The majority of DRPs (80.2%) exhibited marked clinical relevance, mainly due to non-conformance with guidelines (27.4%), unclear indication (27.2%), and the need for patient or drug monitoring (12.5%). Broad-spectrum agents linezolid (25.0%), meropenem (24.1%), ciprofloxacin (15.8%), and piperacillin-tazobactam (8.8%) accounted for nearly 74% of all DRPs. DRP-related interventions aimed at optimizing PK/PD parameters (30.6%), treatment discontinuation (28.1%), and de-escalation (17.9%). The acceptance rate of interventions was high (82.7%). A cost reduction potential was identified in 89.7% of interventions, saving €180,420 in avoided drug expenses.

Conclusion: Pharmacist-led post-prescription interventions within an established AMS program effectively identified clinically relevant misuse of restricted antimicrobials. Targeted actions on key agents enable high-impact optimization, supported by strong acceptance and cost-saving potential - thereby enhancing stewardship efforts, guiding improvements in diagnostics, and prescribing behavior.

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靶向抗菌限制：萨尔茨堡大学医院药剂师领导的管理干预措施的结果。

目的：抗菌药物的过度使用和误用仍然是严峻的挑战。本研究调查了一所大学医院以药剂师为主导的针对限制性抗菌素的处方后干预措施，确定了潜在的药物相关问题（DRPs）、它们的临床相关性、经济影响和不当使用的特征模式。方法：回顾性观察分析（2022年1月至12月）在萨尔茨堡州立医院进行，使用药剂师主导的限制性抗微生物药物干预的常规数据。使用经过验证的标准对DRPs和干预类型进行分类。通过外部调查独立评估临床相关性，并确定判定者之间的信度，以确保分类和评估的一致性。评估了药物干预的潜在成本节约和接受率。结果：共分析3897张限制性抗菌药物处方，366例患者中有11.7%（456张）出现至少一种DRP。大多数drp（80.2%）表现出明显的临床相关性，主要是由于不符合指南（27.4%），适应症不明确（27.2%）以及需要患者或药物监测（12.5%）。广谱药物利奈唑胺（25.0%）、美罗培南（24.1%）、环丙沙星（15.8%）和哌拉西林-他唑巴坦（8.8%）占所有DRPs的近74%。与drp相关的干预措施旨在优化PK/PD参数（30.6%）、停止治疗（28.1%）和降级治疗（17.9%）。干预措施接受率高（82.7%）。在89.7%的干预措施中发现了降低成本的潜力，节省了180,420欧元的药品费用。结论：药剂师主导的处方后干预在建立的AMS项目中有效地识别了临床相关的限制性抗菌素滥用。针对关键药剂采取有针对性的行动，可实现高影响力的优化，并有强大的接受度和节约成本的潜力作为支持，从而加强管理工作，指导改进诊断和处方行为。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.