Impact of Pharmacist-Led Antimicrobial Stewardship on Antibiotic Use in Intensive Care: A Prospective Audit and Feedback Approach

Ergen B., Mülazimoğlu Durmuşoğlu L., Tunçel T., Kasapoğlu U. S., Yalçınkaya E., İlerler E. E., ...Daha Fazla

ESCP Grenoble symposium 2025: From Interprofessional education to interprofessional practice, Grenoble, Fransa, 26 Kasım - 28 Aralık 2025, ss.1, (Özet Bildiri)

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: Grenoble
  • Basıldığı Ülke: Fransa
  • Sayfa Sayıları: ss.1
  • Marmara Üniversitesi Adresli: Evet

Özet

Objective: Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use in intensive care units (ICUs), where high consumption, resistant pathogens and complex pharmacokinetics complicate therapy. Clinical pharmacists play a pivotal role within ASP teams in promoting the proper use of antimicrobials.

Methods: This prospective, observational, pre-post study was conducted in the ICU of a tertiary hospital in Türkiye over six months (October 2024–April 2025), comprising a three-month observation and a three-month ASP period. In the pre-ASP period, systemic antimicrobial use was assessed for appropriateness. In the ASP period, the clinical pharmacist was actively engaged in comprehensive medication reviews, provided targeted educational support to physicians and contributed directly to antimicrobial decision-making processes.  Primary outcomes included appropriateness of antimicrobial therapy, days of therapy (DOT), length of therapy (LOT), and 30-day mortality.

Results: A total of 160 patients and 466 antimicrobial treatments (235 pre-ASP, 231 post-ASP) were evaluated. The antimicrobial inappropriateness rate declined from 81.7% to 8.7% after ASP implementation (p<0.001).The most frequent interventions were dose adjustment (38.3%), initial dose selection (35.2%), and infusion duration modification (15.4%). The acceptance rate of recommendations was 98.1%. Antimicrobial-related problems decreased by 89.6% (p<0.001). 30-day mortality was significantly reduced [RR 0.699, 95% CI 0.505–0.968; p=0.027]. Total DOT and LOT decreased by 8.5% and 19.5%, respectively, though median DOT and LOT per patient-day were not significantly different.

Conclusion: A clinical pharmacist-led audit and feedback intervention in the ICU improved antimicrobial appropriateness and reduced 30-day mortality, highlighting the key role of the clinical pharmacist in optimizing ASP efforts.

Keywords: Antimicrobial stewardship, prospective audit and feedback, clinical pharmacist, intensive care unit