Antimicrobial stewardship : a priority for clinical pharmacists

Abstract

Inappropriate antimicrobial use is a significant cause of antimicrobial resistance and poor patient outcomes. Antimicrobial stewardship aims to ensure optimal treatment. The aim of the study was to determine whether antimicrobial use is appropriate in a cohort of older patients admitted for rehabilitation and to identify factors to be incorporated in a framework that highlights the clinical pharmacist's intervention in antimicrobial stewardship. The study was carried out at Karin Grech Hospital, a rehabilitation hospital. Data collection was standardised through a data collection sheet which was formulated following a literature search and validated for reliability and comprehensiveness by an expert group. The study included patients over 65 years who were prescribed antibiotics for a suspected lower urinary tract infection. Data was collected retrospectively for 98 patients meeting the inclusion criteria from August to December 2022, and was anonymised by the designated intermediary. Appropriateness was assessed in terms of treatment indication, choice, dose/regimen/route. Appropriateness for treatment indication was evaluated on criteria decided by the expert group, while the evaluation of antibiotic choice, dose, regimen, and route was based on local guidelines. Statistical analysis was carried out using IBM SPSS® v 28. Most patients were in the 80-89 age group (60%, n=59) and female (66%, n=65). The mean score of the Charlson Comorbidity Index was 5, and 47% (n=46) of patients were catheterised. Treatment was evaluated as being appropriate in 32% (n=31) of patients and inappropriate in 28% (n=27). In the remaining 40 (41%) patients, treatment appropriateness was classified as inconclusive due to the possibility of another source of infection or the necessity for further data. Inappropriate prescriptions were mainly attributed to failure to adjust treatment to culture and sensitivity test results (44%, n=12), and treatment of asymptomatic patients (30%, n=8). A framework incorporating key factors to be considered in treatment decisions may enhance the clinical pharmacists’ contribution to optimising antimicrobial treatment.