Clinical Pharmacist Interventions Associated with Appropriateness and Lengthof Inpatient Antimicrobial Therapy for Pneumonia
Notice bibliographique
Résumé
Clinical Pharmacist Interventions Associated with Appropriateness and Length of Inpatient Antimicrobial Therapy for Pneumonia Dear Editor: Inappropriate use of antibiotics in the management of pneumonia can lead to the emergence of bacterial resistance and higher costs. The impact of pharmaceutical care for patients with pneumonia is unknown. We conducted a prospective historically controlled study to evaluate the impact of inpatient pharmaceutical care on the use of antibiotics for hospital and community acquired pneumonia at H�spital du Sacr�-Coeur de Montr�al, a tertiary-care teaching hospital affiliated with the University of Montreal. The main endpoint of the study was to compare the mean duration of intravenous antibiotherapy between a group of inpatients receiving pharmaceutical care (intervention group, data collected prospectively from January 1, 2000, to April 7, 2000) and an historical control group that did not receive pharmaceutical care (retrospective chart review for patients hospitalized between January 1, 1998, and May 30, 1998). We also estimated the proportion of antibiotic treatments that were inappropriate in the control group, based on preestablished criteria. A total of 101 patients were included in the study: 43 in the intervention group and 58 in the control group. Patient characteristics were similar between the groups. Mean age was 71.9 in the intervention group and 74.1 in the control group, and the mean pneumonia severity index, as described by Fine, was 110 and 109.31 points, respectively.1 Mean length of intravenous antibiotherapy was 2.3 days shorter in the intervention group (4.4+/-2.5 days) compared to the control group (6.7+/-3.7 days; P=0.0004). This represents a 34% reduction, which is superior to the one-day reduction reported by Bailey et al.2 Mean duration of antibiotherapy during hospitalization was also reduced in the intervention group (8.8+/-2.8 days) compared to the control group (10.3+/-4.2 days; P=0.04). The antibiotic most frequently prescribed was cefuroxime (93%). In the intervention group, pharmacists suggested a switch from intravenous to oral therapy in 46% of cases, a reduction in the dosage or frequency of administration of the antibiotic in 21% of cases, and discontinuation of an antibiotic in 21% of cases. All these recommendations were accepted by the medical team (i.e., treatment modified exactly or partially compared to what the pharmacist suggested). Overall, 33% of the prescriptions were considered inappropriate in the control group (Table 1). Some patients had more than one inappropriate criterion, which explains why we present a cumulative percentage in the table. This study did not demonstrate a significant reduction in acquisition costs of antibiotherapy ($98.9 versus $107.8 in the intervention and control group; P=0.6), which could be explained by the increased use of cefotaxime in the intervention group. The main limitations of our study are that clinical outcomes and length of stay were not evaluated. The positive impact of pharmacists on the duration of hospitalization in patients with various infections has been reported by Przylbylski3 (1.5 days), and Gums4 (3.3 days). Our study brings complementary information on the role and impact of pharmacists on antimicrobial therapy, and the results support the conduct of a study where clinical outcomes and total health care costs would be evaluated.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».