Impact of pharmacist-led antibiotic stewardship program in a PICU of low/middle-income country

摘要

The use of antibiotics in paediatric intensive care units (PICU) is very high (ranging from 67% to 97%) due to several reasons including high incidence of community-acquired sepsis, healthcare-associated infections or as a postoperative prophylaxis.1 This high antibiotic use leads to several problems including development of antibiotic resistance, drug toxicity and drug interactions.2 The Infectious Diseases Society of America and Society for Healthcare Epidemiology of America has initiated antibiotic stewardship programme (ASP) for better delivery of antibiotics in hospitalised patients in 2007 and updated in April 2016, was also advocated by other paediatric healthcare agencies.3 The cornerstone for ASP is appropriate selection, dose and duration of antibiotics. The advantages of ASP include decrease in antimicrobial resistance and cost of care.4 Reports published on ASP in intensive care units have demonstrated significant improvement in consumptions of antibiotics.5 There are limited published reports on paediatric ASP especially related to PICU.6 7 We implemented pharmacist-led ASP in our PICU and compared it with the historical data on the usage of antibiotics in terms of days of therapy (DOT) per 1000 patient days as well as cost of therapy (COT). To assess the effect of implementation of pharmacist-led customised ASP and to compare with historical control on usage of antibiotics as well as COT in our PICU. We conducted a multidisciplinary-team pilot project of pharmacist-led prospective-audit-with-feedback ASP from April.