Skip to main content

Advertisement

SpringerLink
Log in

Impact of medical and pharmaceutical interventions on anti-infective prescriptions: an observational study

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

Abstract

Appropriate prescribing of anti-infectives is a public health challenge. In our hospital, clinical microbiologists (clinical microbiology mobile unit, UMMc) and clinical pharmacists (clinical pharmacy, PHAc) carry out interventions on anti-infective prescriptions to improve practices. Our main objective was to evaluate the acceptance of UMMc and PHAc interventions on anti-infective prescriptions by quantifying the rate of prescription change 24 h after intervention. The secondary objective was to characterize the type of intervention and associate the rate of change for each. All prescriptions are computerized, and interventions traced via DxCare® software, which feeds a local data warehouse (HEGP-CDW). This descriptive, retrospective, single-center, uncontrolled study was conducted from January 2015 to December 2018. The data were extracted over this period from the data warehouse and analyzed using R software. UMMc interventions were accepted 72.2% of the time and PHA interventions 87.3%. The types of interventions found were mostly dose adjustments (61.1% for the UMMc and 54.2% for the PHAc) and proposals to change or stop a drug. Interventions have an impact on anti-infective prescriptions and are generally followed by clinicians. For the category “discontinuation of a molecule”, almost half of the advice from the UMMc was refused. The collaboration between the UMMc and PHAc should be reinforced to improve acceptance.

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
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

From the local clinical data warehouse (HEGP-CDW), following the integrating biology and the bedside (i2b2) standard.

Code availability

Not applicable.

Abbreviations

HEGP-CDW:

Georges-Pompidou European Hospital Clinical Data Warehouse

ATC:

Anatomical Therapeutic Chemical

UMMc:

Clinical Microbiology Mobile Unit

PHAc:

Clinical Pharmacy

References

  1. Davies J, Davies D (2010) Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev 74:417–433. https://doi.org/10.1128/MMBR.00016-10

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M (2014) A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis 14:13. https://doi.org/10.1186/1471-2334-14-13

    Article  PubMed  PubMed Central  Google Scholar 

  3. idsociety. https://www.idsociety.org/policy--advocacy/antimicrobial-resistance/antimicrobial-stewardship n.d. Accessed 23 Aug 2021

  4. Septimus EJ (2018) Antimicrobial resistance. Med Clin North Am 102:819–829. https://doi.org/10.1016/j.mcna.2018.04.005

    Article  PubMed  Google Scholar 

  5. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ et al (2016) Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 62:e51-77. https://doi.org/10.1093/cid/ciw118

    Article  PubMed  PubMed Central  Google Scholar 

  6. Davey P, Brown E, Hartman G (2002) Interventions to improve antibiotic prescribing practices for hospital inpatients. In: The Cochrane Collaboration, editor. The Cochrane Database of Systematic Reviews, Chichester, UK: John Wiley & Sons, Ltd; p. CD003543. https://doi.org/10.1002/14651858.CD003543

  7. Parsels KA, Kufel WD, Burgess J, Seabury RW, Mahapatra R, Miller CD, et al. (2021) Hospital discharge: an opportune time for antimicrobial stewardship. Ann Pharmacother :106002802110526. https://doi.org/10.1177/10600280211052677

  8. Hagiwara D, Sato K, Miyazaki M, Kamada M, Moriwaki N, Nakano T et al (2018) The impact of earlier intervention by an antimicrobial stewardship team for specific antimicrobials in a single weekly intervention. Int J Infect Dis 77:34–39. https://doi.org/10.1016/j.ijid.2018.09.025

    Article  CAS  PubMed  Google Scholar 

  9. Allenet B, Bedouch P, Rose F-X, Escofier L, Roubille R, Charpiat B et al (2006) Validation of an instrument for the documentation of clinical pharmacists’ interventions. Pharm World Sci 28:181–188. https://doi.org/10.1007/s11096-006-9027-5

    Article  PubMed  Google Scholar 

  10. Prokosch HU, Ganslandt T (2009) Perspectives for medical informatics. Reusing the electronic medical record for clinical research. Methods Inf Med 48:38–44

    Article  CAS  Google Scholar 

  11. Jannot A-S, Zapletal E, Avillach P, Mamzer M-F, Burgun A, Degoulet P (2017) The Georges Pompidou University Hospital Clinical Data Warehouse: a 8-years follow-up experience. Int J Med Informatics 102:21–28. https://doi.org/10.1016/j.ijmedinf.2017.02.006

    Article  Google Scholar 

  12. Geissbuhler A, Safran C, Buchan I, Bellazzi R, Labkoff S, Eilenberg K et al (2013) Trustworthy reuse of health data: a transnational perspective. Int J Med Informatics 82:1–9. https://doi.org/10.1016/j.ijmedinf.2012.11.003

    Article  CAS  Google Scholar 

  13. Murphy SN, Weber G, Mendis M, Gainer V, Chueh HC, Churchill S et al (2010) Serving the enterprise and beyond with informatics for integrating biology and the bedside (i2b2). J Am Med Inform Assoc 17:124–130. https://doi.org/10.1136/jamia.2009.000893

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shams K, Farishta M (2001) Data warehousing: toward knowledge management. Top Health Inf Manage 21:24–32

    CAS  PubMed  Google Scholar 

  15. Zapletal E, Rodon N, Grabar N, Degoulet P (2010) Methodology of integration of a clinical data warehouse with a clinical information system: the HEGP case. Stud Health Technol Inform 160:193–197

    PubMed  Google Scholar 

  16. Villanueva P, Freyne B, Hickey L, Carr J, Bryant PA (2021) Impact of an antimicrobial stewardship intervention in neonatal intensive care: recommendations and implementation. J Paediatr Child Health 57:1208–1214. https://doi.org/10.1111/jpc.15427

    Article  PubMed  Google Scholar 

  17. Dixit D, Ranka R, Panda PK (2021) Compliance with the 4Ds of antimicrobial stewardship practice in a tertiary care centre. JAC Antimicrob Resist 3:dlab135. https://doi.org/10.1093/jacamr/dlab135

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alba Fernandez J, Del Pozo JL, Leiva J, Fernandez-Alonso M, Aquerreta I, Aldaz A et al (2022) Impact of the acceptance of the recommendations made by a Meropenem Stewardship Program in a University Hospital: A Pilot Study. Antibiotics (Basel) 11:330. https://doi.org/10.3390/antibiotics11030330

    Article  CAS  Google Scholar 

  19. Loo LW, Liew YX, Lee W, Lee LW, Chlebicki P, Kwa AL-H (2019) Discontinuation of antibiotic therapy within 24 hours of treatment initiation for patients with no clinical evidence of bacterial infection: a 5-year safety and outcome study from Singapore General Hospital Antimicrobial Stewardship Program. Int J Antimicrob Agents 53:606–11. https://doi.org/10.1016/j.ijantimicag.2019.01.008

    Article  CAS  PubMed  Google Scholar 

  20. Bouchet F, Le Moing V, Dirand D, Cros F, Lienard A, Reynes J et al (2020) Effectiveness and acceptance of multimodal antibiotic stewardship program: considering progressive implementation and complementary strategies. Antibiotics 9:848. https://doi.org/10.3390/antibiotics9120848

    Article  CAS  PubMed Central  Google Scholar 

  21. Rashidzada Z, Cairns KA, Peel TN, Jenney AW, Doyle JS, Dooley MJ et al (2021) Early antimicrobial stewardship team intervention on appropriateness of antimicrobial therapy in suspected sepsis: a randomized controlled trial. JAC Antimicrob Resist 3:dlab097. https://doi.org/10.1093/jacamr/dlab097

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pauquet E, Coppry M, Sarlangue J, Rogues A-M (2021) Carbapenem stewardship program in a French university children’s hospital. Arch Pediatr 28:621–625. https://doi.org/10.1016/j.arcped.2021.10.004

    Article  CAS  PubMed  Google Scholar 

  23. Yeo C-L, Chan DS-G, Earnest A, Wu T-S, Yeoh S-F, Lim R et al (2012) Prospective audit and feedback on antibiotic prescription in an adult hematology-oncology unit in Singapore. Eur J Clin Microbiol Infect Dis 31:583–90. https://doi.org/10.1007/s10096-011-1351-6

    Article  PubMed  Google Scholar 

  24. Waters CD (2015) Pharmacist-driven antimicrobial stewardship program in an institution without infectious diseases physician support. Am J Health Syst Pharm 72:466–468. https://doi.org/10.2146/ajhp140381

    Article  PubMed  Google Scholar 

  25. Mas-Morey P, Valle M (2018) A systematic review of inpatient antimicrobial stewardship programmes involving clinical pharmacists in small-to-medium-sized hospitals. Eur J Hosp Pharm 25:e69-73. https://doi.org/10.1136/ejhpharm-2017-001381

    Article  PubMed  Google Scholar 

  26. Abubakar U, Syed Sulaiman SA, Adesiyun AG (2019) Impact of pharmacist-led antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis in obstetric and gynecologic surgeries in Nigeria. PLoS ONE 14:e0213395. https://doi.org/10.1371/journal.pone.0213395

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Al Raiisi F, Stewart D, Fernandez-Llimos F, Salgado TM, Mohamed MF, Cunningham S (2019) Clinical pharmacy practice in the care of Chronic Kidney Disease patients: a systematic review. Int J Clin Pharm 41:630–666. https://doi.org/10.1007/s11096-019-00816-4

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lombardi N, Wei L, Ghaleb M, Pasut E, Leschiutta S, Rossi P et al (2018) Evaluation of the implementation of a clinical pharmacy service on an acute internal medicine ward in Italy. BMC Health Serv Res 18:259. https://doi.org/10.1186/s12913-018-2988-y

    Article  PubMed  PubMed Central  Google Scholar 

  29. Loustalot M-C, Berdot S, Sabatier P, Durieux P, Perrin G, Karras A et al (2019) The impact of interventions by pharmacists collected in a computerised physician order entry context: a prospective observational study with a 10-year reassessment. Swiss Med Wkly. https://doi.org/10.4414/smw.2019.20015

    Article  PubMed  Google Scholar 

  30. Caruba T, Colombet I, Gillaizeau F, Bruni V, Korb V, Prognon P et al (2010) Chronology of prescribing error during the hospital stay and prediction of pharmacist’s alerts overriding: a prospective analysis. BMC Health Serv Res 10:13. https://doi.org/10.1186/1472-6963-10-13

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. (2012) Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev: CD000259. https://doi.org/10.1002/14651858.CD000259.pub3

  32. Durand A, Gillibert A, Membre S, Mondet L, Lenglet A, Mary A (2022) Acceptance factors for in-hospital pharmacist interventions in daily practice: a retrospective study. Front Pharmacol 13:811289. https://doi.org/10.3389/fphar.2022.811289

    Article  PubMed  PubMed Central  Google Scholar 

  33. Howard J, Hart N, Roberts-Harewood M, Cummins M, Awogbade M, Davis B et al (2015) Guideline on the management of acute chest syndrome in sickle cell disease. Br J Haematol 169:492–505. https://doi.org/10.1111/bjh.13348

    Article  PubMed  Google Scholar 

  34. Kjærsgaard M, Leth RA, Udupi A, Ank N (2019) Antibiotic stewardship based on education: minor impact on knowledge, perception and attitude. Infect Dis 51:753–763. https://doi.org/10.1080/23744235.2019.1648856

    Article  Google Scholar 

  35. Wang H, Wang H, Yu X, Zhou H, Li B, Chen G et al (2019) Impact of antimicrobial stewardship managed by clinical pharmacists on antibiotic use and drug resistance in a Chinese hospital, 2010–2016: a retrospective observational study. BMJ Open 9:e026072. https://doi.org/10.1136/bmjopen-2018-026072

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ourghanlian C, Lapidus N, Antignac M, Fernandez C, Dumartin C, Hindlet P (2020) Pharmacists’ role in antimicrobial stewardship and relationship with antibiotic consumption in hospitals: an observational multicentre study. Journal of Global Antimicrobial Resistance 20:131–134. https://doi.org/10.1016/j.jgar.2019.07.009

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 75015, Paris, France

    Emma Pinet, B. Sabatier & T. Caruba

  2. Medical Information Department, Georges Pompidou European Hospital, AP-HP, 75015, Paris, France

    P. Sabatier & A. S. Jannot

  3. University Paris, INSERM U1138, 75006, Paris, France

    P. Sabatier, A. S. Jannot, J. L. Mainardi & B. Sabatier

  4. Infectious Disease Department, Georges Pompidou European Hospital, AP-HP, 75015, Paris, France

    M. P. Fernandez-Gerlinger & J. L. Mainardi

Authors
  1. Emma Pinet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Sabatier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. P. Fernandez-Gerlinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. S. Jannot
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. L. Mainardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Sabatier
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Caruba
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Not applicable.

Corresponding author

Correspondence to Emma Pinet.

Ethics declarations

Ethics approval

Approved by the local ethics research committee (institutional review board) CERAPHP.CENTRE under registration number #350481, reference 2018–12-05.

Consent to participate

Not applicable.

Consent for publication.

Not applicable.

Conflicts of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pinet, E., Sabatier, P., Fernandez-Gerlinger, M.P. et al. Impact of medical and pharmaceutical interventions on anti-infective prescriptions: an observational study. Eur J Clin Microbiol Infect Dis 41, 1077–1086 (2022). https://doi.org/10.1007/s10096-022-04465-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-022-04465-w

Keywords

Search

Navigation