Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness

Abstract Antimicrobials are the most frequently prescribed drugs in long-term care facilities (LTCF). Antibiotic stewardship programs (ASP) are coordinated interventions promoting the responsible use of antibiotics to improve patient outcomes and reduce antibiotic resistant bacterias. The objectives...

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Autores principales:	María Rosa Cantudo-Cuenca, Alberto Jimenez-Morales, Juan Enrique Martínez-de la Plata
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/13c5905a2ded4014a323753ac0d9fd9e
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spelling	oai:doaj.org-article:13c5905a2ded4014a323753ac0d9fd9e2021-12-02T17:27:02ZPharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness10.1038/s41598-021-98431-92045-2322https://doaj.org/article/13c5905a2ded4014a323753ac0d9fd9e2021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-98431-9https://doaj.org/toc/2045-2322Abstract Antimicrobials are the most frequently prescribed drugs in long-term care facilities (LTCF). Antibiotic stewardship programs (ASP) are coordinated interventions promoting the responsible use of antibiotics to improve patient outcomes and reduce antibiotic resistant bacterias. The objectives are to evaluate the effectiveness of a pharmacist-led ASP in a LTCF, to characterise antibiotic therapy and assess the appropriateness of antibiotic prescriptions. A prospective quasi-experimental study to implement an ASP in a LTCF. Antibiotic prescriptions for suspected infections initiated in any setting for LTCF residents were included. We assessed appropriateness and prospective audits and feedback of each inappropriate antimicrobial prescription were carried out. Associations of variables with appropriate antibiotic prescribing were estimated using logistic regression. A total of 416 antibiotic prescriptions were included. The mean consumption of antibiotics was reduced from 63.2 defined daily doses per 1000 residents-days (DRD) in the preintervention period to 22.8 in the intervention period (− 63.8%), with a signifcant drop in fluoroquinolones (81.4%). Overall, 46.6% of antibiotic prescriptions were judged inappropriate, mainly because of a use not recommended in treatment guidelines (63.2%). Multivariable analysis showed that empirical therapy, some classes of antibiotics (cephalosporins, fluoroquinolones, fosfomycin calcium, macrolides) and prescription initiation in the emergency department were independent predictors of antimicrobial inappropriateness. Pharmacist-led ASP in a LTCF has being effective in reducing consumption of antibiotics by improving appropriateness of treatment decisions. However, ASP should include interventions in the emergency department because of the high inappropriate use in this setting.María Rosa Cantudo-CuencaAlberto Jimenez-MoralesJuan Enrique Martínez-de la PlataNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q María Rosa Cantudo-Cuenca Alberto Jimenez-Morales Juan Enrique Martínez-de la Plata Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness
description	Abstract Antimicrobials are the most frequently prescribed drugs in long-term care facilities (LTCF). Antibiotic stewardship programs (ASP) are coordinated interventions promoting the responsible use of antibiotics to improve patient outcomes and reduce antibiotic resistant bacterias. The objectives are to evaluate the effectiveness of a pharmacist-led ASP in a LTCF, to characterise antibiotic therapy and assess the appropriateness of antibiotic prescriptions. A prospective quasi-experimental study to implement an ASP in a LTCF. Antibiotic prescriptions for suspected infections initiated in any setting for LTCF residents were included. We assessed appropriateness and prospective audits and feedback of each inappropriate antimicrobial prescription were carried out. Associations of variables with appropriate antibiotic prescribing were estimated using logistic regression. A total of 416 antibiotic prescriptions were included. The mean consumption of antibiotics was reduced from 63.2 defined daily doses per 1000 residents-days (DRD) in the preintervention period to 22.8 in the intervention period (− 63.8%), with a signifcant drop in fluoroquinolones (81.4%). Overall, 46.6% of antibiotic prescriptions were judged inappropriate, mainly because of a use not recommended in treatment guidelines (63.2%). Multivariable analysis showed that empirical therapy, some classes of antibiotics (cephalosporins, fluoroquinolones, fosfomycin calcium, macrolides) and prescription initiation in the emergency department were independent predictors of antimicrobial inappropriateness. Pharmacist-led ASP in a LTCF has being effective in reducing consumption of antibiotics by improving appropriateness of treatment decisions. However, ASP should include interventions in the emergency department because of the high inappropriate use in this setting.
format	article
author	María Rosa Cantudo-Cuenca Alberto Jimenez-Morales Juan Enrique Martínez-de la Plata
author_facet	María Rosa Cantudo-Cuenca Alberto Jimenez-Morales Juan Enrique Martínez-de la Plata
author_sort	María Rosa Cantudo-Cuenca
title	Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness
title_short	Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness
title_full	Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness
title_fullStr	Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness
title_full_unstemmed	Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness
title_sort	pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/13c5905a2ded4014a323753ac0d9fd9e
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Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness

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