Impact of an Infectious Disease Pharmaceutical Care Model in an Antibiotic Stewardship Program on Anti-Pseudomonal Carbapenem (Imipenem, Meropenem) Consumption: A Pilot Study

抗生素管理計畫導入感染專科臨床藥事照護模式對抗綠膿桿菌Carbapenem類抗生素之影響

張筱琳(Hsiao-Lin Chang) ； 潘韻晴(Jean Yun-Ching Pan) ； 柯政欽(Chen-Chin Ko) ； 宋季純(Chi-Chun Sung) ； 劉麗珠(Li-Chu Liu)

《臺灣臨床藥學雜誌》 23卷1期 (2015/03) Pp. 23-31

https://doi.org/10.6168/FJCP.2015.2301.03

摘要

目的：建立感染專科臨床藥事照護模式，經臨床藥師介入carbapenems類抗生素合理使用，以降低anti-pseudomonal carbapenems（imipenem及meropenem）的耗用量達10%以上及降低藥費。方法：建立感染專科臨床藥事照護模式，由ICU臨床藥師與感染專科臨床藥師執行臨床藥事服務，與醫師共同查房、提供抗生素藥品諮詢及治療評估、病人用藥建議、不良反應評估等。經由臨床藥事服務過程評估病患所有使用之抗生素之合理性（含carbapenems）並提供醫師適當之用藥建議。臨床藥師於住院病人後線抗生素處方開立後24小時內，評估該病人所有抗生素使用適當性並記錄分析carbapenems類抗生素耗用量與藥費。結果：經過8個月的導入感染專科臨床藥事照護模式，imipenem總耗用量減少17%、Meropenem減少18%。carbapenems類抗生素總耗用量減少5%。carbapenems類抗生素總藥費減少12%。藥師介入carbapenems類抗生素合理性使用共248件，其中carbapenem抗生素之不合理使用共59件，醫師接受率達88%。介入原因包括抗生素選用不適當44%、需劑量調整29%、輸液相容性問題19%、藥物交互作用3%、藥物不良反應3%及未做細菌培養2%。結論：抗生素管理計畫中導入「感染專科臨床藥事照護模式」能成功減少anti-pseudomonal carbapenems類抗生素（imipenem及meropenem）的耗用量與減少carbapenems類抗生素之總藥費。此感染專科臨床藥事照護模式適合落實於平日的臨床藥事照護當中。

關鍵字

感染專科臨床藥事照護模式 ； 臨床藥師

並列摘要

Background: ＂Acinetobacter baumannii＂ complex infections are associated with high morbidity, mortality and cost. Increased use of anti-pseudomonal carbapenems (imipenem, meropenem) was associated with increased rates of carbapenem-resistant acinetobacter baumanni (CRAB) isolates. Pharmacist intervention can play a major role in the appropriate use of antibiotics. Objectives: To evaluate the impact of an infectious disease pharmaceutical care model (IDPCM) in an antibiotic stewardship program on anti-pseudomonal carbapenem consumption and expenditure. Methods: Training of pharmacists began in August 2013. The IDPCM was implemented in January 2014 which included intensive care unit (ICU) pharmaceutical care, infectious disease pharmaceutical care and evaluation of antibiotic prescriptions including carbapenems. In ward rounds, clinical pharmacists presented cases with the need for antimicrobial changes and complicated patients on broad-spectrum antimicrobials. Pharmacists provided suggestions for changes to antibiotic use to doctors. Comparison of carbapenem consumption and cost pre- and post-implementation of the IDPCM were conducted between the periods January to August 2013 and 2014. Results: Four pharmacists completed training and participated in an antibiotic stewardship program. Imipenem, meropenem and total carbapenems consumption decreased 17%, 18% and 5% respectively. Total carbapenem expenditure declined by 12%. 248 interventions were made by clinical pharmacists (including 59 carbapenem interventions) during the 8-month study period. The doctors' acceptance rate was 88%. The most common interventions were inappropriate antibiotic selection 44%, dose adjustment 29%, and IV incompatibility 19%. Conclusion: Implementation of IDPCM in an antibiotic stewardship program can decrease the carbapenem consumption and decrease total carbapenem expenditure. This pharmaceutical care model could be implemented into daily practice.

並列關鍵字

Infectious Disease Pharmaceutical Care Model ； Carbapenem-Resistant ＂Acinetobacter Baumanni＂ ； Carbapenem ； Clinical Pharmacist