PROA effect with active monitoring by a clinical pharmacist on clinical and economic outcomes in hospitalized patients in the surgical intermediated care unit at a University Hospital.

Abstract

Background: Antimicrobial stewardship programs (ASPs) are aimed at delaying antimicrobial resistance. A hospital’s surgical intermediate care unit (SIMCU) is where the ASP is essential. Aim: To determine the impact of the clinical pharmacist, a member of the ASP, on the use of antimicrobials in the SIMCU. Methodology: Quasi-experimental, before-and-after study, with each phase lasting 6 months. One hundred patients were recruited, 50 in each phase. The primary effect evaluated was the comparison of treatment days. Adverse effects included hospital stay, inappropriate prescriptions (IP), clinical failure (CF), and the consumption and costs related to antimicrobials. Results: A 12% decrease in the duration of antibiotic therapy was observed (p value= 0.055). The hospital stay decreased by 16.4% (p value<0.001). It was therefore determined that the treated patients had a lower risk of presenting an antimicrobial IP (OR 0.148; 95% CI 0.038- 0.573; p value= 0.006) and a lower risk of presenting CF (OR 0.181; 95% CI 0.056-0.580; p value= 0.04). Antimicrobial-related costs were reduced by 37%, an institutional savings of CLP 24,073,891 (approximately USD 25,644). Conclusion: The implementation of the ASP in the SIMCU resulted in a reduction in overall treatment days and hospital stays.

Keywords:  Antimicrobial stewardship program, chemist, clinical pharmacist, pharmaceutical interventions, antimicrobials.