Longitudinal impact of a pharmacist-led stepwise antimicrobial stewardship program on intravenous antimicrobial use at a small resource-limited Japanese hospital

Background

Clinical pharmacists play a central role in the implementation of antimicrobial stewardship programs (ASP). However, personnel shortages, the lack of a system for career development, and other challenges impede the active contribution of clinical pharmacists to ASPs in Japan.

Aim

To conduct a long-term evaluation of a pharmacist-led antimicrobial stewardship program.

Methods

The present, retrospective study used segmented time-series analysis to examine antimicrobial consumption, blood culture practices, and the rate of resistance in pathogens to the antimicrobials prescribed.

Findings

After the ASP was introduced, days of therapy (DOT) with anti-pseudomonal agents demonstrated a downward trend (−0.31; 95 % confidence interval [CI]: −0.43 to −0.19; p < 0.01). Moreover, the trend in the number of blood cultures after the intervention significantly increased (0.20; 95 % CI: 0.05 to 0.35; p = 0.01), and the rate of resistance of Pseudomonas aeruginosa to cefepime and piperacillin decreased. No significant change was observed in the DOT trend for total intravenous antimicrobial use before or after the intervention (−1.07; 95 % CI: −2.44 to 0.29; p = 0.12).

Conclusion

Although the role of pharmacists in an ASP should continue to be examined, the present, longitudinal study found that stepwise introduction of an ASP reduced broad-spectrum antimicrobial use and was associated with a decrease in the antimicrobial resistance rate of Pseudomonas aeruginosa but not of third-generation cephalosporin-resistant Escherichia coli or MRSA.