Pharmacist-driven antibiotic stewardship program in febrile neutropenic
patients: A Prospective study
Abstract
Aim: To determine role of pharmacists in an antibiotic stewardship
program (ASP) for febrile neutropenic patients. Methods: A prospective
study in four medical wards at Thammasat University Hospital between
August 2019 and April 2020. Two medical wards were designated as the
pharmacist-driven ASP group and two other medical wards were designated
as a control group. Our primary outcome was to compare appropriate use
of target antibiotics between the pharmacist-driven ASP group and
control group. Results: The results showed 90 febrile neutropenic events
in 66 patients. Choice of an appropriate antibiotic was significantly
higher in the pharmacist-driven ASP group than the control group (88.9%
versus 51.1%, p<0.001). Furthermore, there was greater
appropriateness of the dosage regimen chosen as empirical therapy in the
pharmacist-driven ASP group than in the control group (97.8% versus
88.7%, p=0.049) and proper duration of target antibiotics in
documentation therapy (91.1% versus 75.6%, p=0.039). Although the
pharmacist-driven ASP did not affect 30-day infectious diseases-related
mortality and length of stay (p=0.810 and 0.267, respectively),
multivariate analysis showed that pharmacist-driven ASP and infectious
diseases consultation had favorable impact on 30-day infectious
diseases-related mortality in chemotherapy induced febrile neutropenic
patients (OR 0.082, 95%CI: 0.009-0.762, P = 0.028). Conclusions: Our
study demonstrated that clinical pharmacists could implement an
antibiotic stewardship program for febrile neutropenic patients.
Pharmacist-driven ASP could be a great opportunity to improve antibiotic
appropriateness in febrile neutropenic patients.