Pharmacist-led multidisciplinary review of carbapenem use in inpatients: A quasi-experimental study

Abstract

Objective

To evaluate the effect of a clinical pharmacist-led multidisciplinary team (MDT) review model on the appropriateness of carbapenem use amongst inpatients.

Methods

This study employed a quasi-experimental, pre-post design. We retrospectively analysed 1086 inpatient cases receiving carbapenem therapy between 2020 and 2024. From 2023 onward, an MDT comprising clinical pharmacists, infectious disease specialists, and microbiologists systematically reviewed medical orders against standardised criteria and provided evidence-based recommendations.

Results

Post-intervention, the appropriateness of initial carbapenem prescriptions increased from 77.08% to 83.79%, whereas re-evaluation appropriateness improved from 78.94% to 87.00% (P < .05). Pharmacist intervention acceptance rates rose significantly from 56.04% to 82.35% (P < .05). Additionally, median hospital length of stay decreased (19 vs. 15 days), with notable reductions in ICU admission (59.95% vs. 31.50%) and mortality rates (15.51% vs. 4.28%) (P < .001). Multivariable regression identified hepatic/renal dysfunction and hypoalbuminemia as independent risk factors for ICU admission, whereas ICU admission itself strongly predicted mortality. Notably, the detection rates of carbapenem-resistant Klebsiella pneumoniae and Pseudomonas aeruginosa increased during the intervention period.

Conclusions

The clinical pharmacist-led MDT model enhances carbapenem-prescribing appropriateness and fosters interprofessional collaboration. Its implementation was associated with shorter hospital stays and improvements in key clinical indicators, including reduced ICU admission and mortality. However, the observed shifts in resistant pathogen epidemiology underscore that antimicrobial stewardship strategies must be integrated with rigorous infection prevention and control measures to simultaneously optimise therapeutic outcomes and mitigate resistance.