Skip to main content

Advertisement

SpringerLink
Log in

Evidence of clinical and economic impact of pharmacist interventions related to antimicrobials in the hospital setting

  • Review
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The purpose of this paper was to review the literature regarding the clinical and economic impact of pharmacist interventions (PIs) related to antimicrobials in the hospital setting. A PubMed literature search from January 2003 to March 2016 was conducted using the terms pharmacist* or clinical pharmacist* combined with antimicrobial* or antibiotic* or anti-infective*. Comparative studies that assessed the clinical and/or economic impact of PIs on antimicrobials in the hospital setting were reviewed. Outcomes were classified as: treatment-related outcomes (TROs), clinical outcomes (COs), cost and microbiological outcomes (MOs). Acceptance of pharmacist recommendations by physicians was collected. PIs were grouped into patient-specific recommendations (PSRs), policy, and education. Studies’ risk of bias was analyzed using Cochrane’s tool. Twenty-three studies were evaluated. All of them had high risk of bias. The design in most cases was uncontrolled before and after. PSRs were included in every study; five also included policy and four education. Significant impact of PI was found in 14 of the 18 studies (77.8%) that evaluated costs, 15 of the 20 studies (75.0%) that assessed TROs, 12 of the 22 studies (54.5%) that analyzed COs, and one of the two studies (50.0%) that evaluated MOs. None of the studies found significant negative impact of PIs. It could not be concluded that adding other strategies to PSRs would improve results. Acceptance of recommendations varied from 70 to 97.5%. Pharmacists improve TROs and COs, and decrease costs. Additional research with a lower risk of bias is unlikely to change this conclusion. Future research should focus on identifying the most efficient interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Morante M, Matoses-Chirivella CA, Rodríguez-Lucena FJ, Del Moral JM, Ruiz-García M, Navarro-Ruiz A (2014) Pharmaceutical intervention in duration of antimicrobial treatment at hospital ambit. Rev Esp Quimioter 27:159–169

    CAS  PubMed  Google Scholar 

  2. von Gunten V, Reymond JP, Beney J (2007) Clinical and economic outcomes of pharmaceutical services related to antibiotic use: a literature review. Pharm World Sci 29:146–163

    Article  Google Scholar 

  3. Grill E, Weber A, Lohmann S, Vetter-Kerkhoff C, Strobl R, Jauch KW (2011) Effects of pharmaceutical counselling on antimicrobial use in surgical wards: intervention study with historical control group. Pharmacoepidemiol Drug Saf 20:739–746. https://doi.org/10.1002/pds.2126

    Article  PubMed  Google Scholar 

  4. Shen J, Sun Q, Zhou X, Wei Y, Qi Y, Zhu J, Yan T (2011) Pharmacist interventions on antibiotic use in inpatients with respiratory tract infections in a Chinese hospital. Int J Clin Pharm 33:929–933. https://doi.org/10.1007/s11096-011-9577-z

    Article  PubMed  Google Scholar 

  5. Wang J, Dong M, Lu Y, Zhao X, Li X, Wen A (2015) Impact of pharmacist interventions on rational prophylactic antibiotic use and cost saving in elective cesarean section. Int J Clin Pharmacol Ther 53:605–615. https://doi.org/10.5414/CP202334

    Article  CAS  PubMed  Google Scholar 

  6. De Rijdt T, Willems L, Simoens S (2008) Economic effects of clinical pharmacy interventions: a literature review. Am J Health Syst Pharm 65:1161–1172. https://doi.org/10.2146/ajhp070506

    Article  PubMed  Google Scholar 

  7. Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, Gould IM, Ramsay CR, Michie S (2017) Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2:CD003543. https://doi.org/10.1002/14651858.CD003543.pub4

    PubMed  Google Scholar 

  8. Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N (2011) Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 66:1223–1230. https://doi.org/10.1093/jac/dkr137

    Article  CAS  PubMed  Google Scholar 

  9. Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E (2016) Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial stewardship programs. Antimicrob Agents Chemother 60:4840–4852. https://doi.org/10.1128/AAC.00825-16

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Schuts EC, Hulscher MEJL, Mouton JW, Verduin CM, Stuart JWTC, Overdiek HWPM, van der Linden PD, Natsch S, Hertogh CMPM, Wolfs TFW, Schouten JA, Kullberg BJ, Prins JM (2016) Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis 16:847–856. https://doi.org/10.1016/S1473-3099(16)00065-7

    Article  PubMed  Google Scholar 

  11. Higgins JPT, Green S (eds) (2011) Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. The Cochrane Collaboration. Available online at: http://handbook.cochrane.org. Accessed 8 Apr 2016

  12. Davis SL, Delgado G Jr, McKinnon PS (2005) Pharmacoeconomic considerations associated with the use of intravenous-to-oral moxifloxacin for community-acquired pneumonia. Clin Infect Dis 41:S136–S143

    Article  PubMed  Google Scholar 

  13. Davis LC, Covey RB, Weston JS, Hu BB, Laine GA (2016) Pharmacist-driven antimicrobial optimization in the emergency department. Am J Health Syst Pharm 73:S49–S56. https://doi.org/10.2146/sp150036

    Article  PubMed  Google Scholar 

  14. Zhou L, Ma J, Gao J, Chen S, Bao J (2016) Optimizing prophylactic antibiotic practice for cardiothoracic surgery by pharmacists’ effects. Medicine (Baltimore) 95:e2753. https://doi.org/10.1097/MD.0000000000002753

    Article  CAS  Google Scholar 

  15. Marquis KA, DeGrado JR, Labonville S, Kubiak DW, Szumita PM (2015) Evaluation of a pharmacist-directed Vancomycin dosing and monitoring pilot program at a tertiary academic medical center. Ann Pharmacother 49:1009–1014. https://doi.org/10.1177/1060028015587900

    Article  CAS  PubMed  Google Scholar 

  16. Tavakoli-Ardakani M, Ghassemi S, Alizadeh AM, Salamzadeh J, Ghadiani M, Ghassemi S (2015) Effects of pharmacist intervention on the utilization of vancomycin in a teaching hospital. Iran J Pharm Res 14:1281–1288

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Zhou Y, Ma LY, Zhao X, Tian SH, Sun LY, Cui YM (2015) Impact of pharmacist intervention on antibiotic use and prophylactic antibiotic use in urology clean operations. J Clin Pharm Ther 40:404–408. https://doi.org/10.1111/jcpt.12275

    Article  CAS  PubMed  Google Scholar 

  18. Jiang SP, Xu YY, Ping-Yang, Wu WF, Zhang XG, Lu XY, Xiao YH, Liang WF, Chen J (2014) Improving antimicrobial dosing in critically ill patients receiving continuous venovenous hemofiltration and the effect of pharmacist dosing adjustment. Eur J Intern Med 25:930–935. https://doi.org/10.1016/j.ejim.2014.08.001

    Article  PubMed  Google Scholar 

  19. Reed EE, West JE, Keating EA, Pancholi P, Balada-Llasat JM, Mangino JE, Bauer KA, Goff DA (2014) Improving the management of candidemia through antimicrobial stewardship interventions. Diagn Microbiol Infect Dis 78:157–161. https://doi.org/10.1016/j.diagmicrobio.2013.11.012

    Article  PubMed  Google Scholar 

  20. Yagi Y, Okazaki M, Higaki H, Nakai M, Hirata A, Miyamura M (2014) Outcome evaluation of an intervention to improve the effective and safe use of meropenem. Int J Clin Pharm 36:648–656. https://doi.org/10.1007/s11096-014-9949-2

    Article  CAS  PubMed  Google Scholar 

  21. Zhang HX, Li X, Huo HQ, Liang P, Zhang JP, Ge WH (2014) Pharmacist interventions for prophylactic antibiotic use in urological inpatients undergoing clean or clean-contaminated operations in a Chinese hospital. PLoS One 9:e88971. https://doi.org/10.1371/journal.pone.0088971

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jiang SP, Zhu ZY, Ma KF, Zheng X, Lu XY (2013) Impact of pharmacist antimicrobial dosing adjustments in septic patients on continuous renal replacement therapy in an intensive care unit. Scand J Infect Dis 45:891–899. https://doi.org/10.3109/00365548.2013.827338

    Article  PubMed  Google Scholar 

  23. Yen YH, Chen HY, Wuan-Jin L, Lin YM, Shen WC, Cheng KJ (2012) Clinical and economic impact of a pharmacist-managed i.v.-to-p.o. conversion service for levofloxacin in Taiwan. Int J Clin Pharmacol Ther 50:136–141

    Article  CAS  PubMed  Google Scholar 

  24. Dunn K, O’Reilly A, Silke B, Rogers T, Bergin C (2011) Implementing a pharmacist-led sequential antimicrobial therapy strategy: a controlled before-and-after study. Int J Clin Pharm 33:208–214. https://doi.org/10.1007/s11096-010-9475-9

    Article  PubMed  Google Scholar 

  25. Randolph TC, Parker A, Meyer L, Zeina R (2011) Effect of a pharmacist-managed culture review process on antimicrobial therapy in an emergency department. Am J Health Syst Pharm 68:916–919. https://doi.org/10.2146/ajhp090552

    Article  PubMed  Google Scholar 

  26. Toth NR, Chambers RM, Davis SL (2010) Implementation of a care bundle for antimicrobial stewardship. Am J Health Syst Pharm 67:746–749. https://doi.org/10.2146/ajhp090259

    Article  PubMed  Google Scholar 

  27. Bond CA, Raehl CL (2007) Clinical and economic outcomes of pharmacist-managed antimicrobial prophylaxis in surgical patients. Am J Health Syst Pharm 64:1935–1942

    Article  PubMed  Google Scholar 

  28. Bond CA, Raehl CL (2005) Clinical and economic outcomes of pharmacist-managed aminoglycoside or vancomycin therapy. Am J Health Syst Pharm 62:1596–1605

    Article  PubMed  Google Scholar 

  29. Ho BP, Lau TT, Balen RM, Naumann TL, Jewesson PJ (2005) The impact of a pharmacist-managed dosage form conversion service on ciprofloxacin usage at a major Canadian teaching hospital: a pre- and post-intervention study. BMC Health Serv Res 5:48

    Article  PubMed  PubMed Central  Google Scholar 

  30. von Gunten V, Troillet N, Beney J, Boubaker K, Lüthi JC, Taffé P, Reymond JP (2005) Impact of an interdisciplinary strategy on antibiotic use: a prospective controlled study in three hospitals. J Antimicrob Chemother 55:362–366

    Article  Google Scholar 

  31. Pinteño Blanco M, Delgado Sánchez O, Escrivá Torralva A, Crespí Monjo M, Ventayol Bosch P, Puigventós Latorre F, Martínez López I (2004) A prospective comparative study to assess the impact of pharmaceutical intervention in the promotion of sequential therapy with flouroquinolones. Farm Hosp 28:419–425

    PubMed  Google Scholar 

  32. Patel D, Lawson W, Guglielmo BJ (2008) Antimicrobial stewardship programs: interventions and associated outcomes. Expert Rev Anti Infect Ther 6:209–222. https://doi.org/10.1586/14787210.6.2.209

    Article  PubMed  Google Scholar 

Download references

Funding

No sources of funding were used in preparing this report.

Author information

Authors and Affiliations

  1. Pharmacy Services, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain

    L. Leache, I. Aquerreta, A. Aldaz, A. Idoate & A. Ortega

Authors
  1. L. Leache
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Aquerreta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Aldaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Idoate
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Ortega
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Leache.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Declaration of preliminary publication

Part of the content of this work was presented as a poster at the 22nd Congress of the European Association of Hospital Pharmacists (EAHP), Cannes, France, March 2017.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 199 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leache, L., Aquerreta, I., Aldaz, A. et al. Evidence of clinical and economic impact of pharmacist interventions related to antimicrobials in the hospital setting. Eur J Clin Microbiol Infect Dis 37, 799–822 (2018). https://doi.org/10.1007/s10096-017-3166-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-017-3166-6

Keywords

Search

Navigation