Back-end approach antimicrobial stewardship program in a cardiology center in Brazil – the pharmacist role

Background: Multidisciplinary teams as well as institutional support are needed to form effective committees to monitor antimicrobial use.

Objective: To determine the role of the pharmacist as member of a multidisciplinary team responsible for implementation of an antimicrobial stewardship program (ASP) we present the results of a quasi-experiment study in a cardiology center in Brazil. Methods: The program initiated with an infectious disease (ID) physician and then a pharmacist started to work with ID specialist. We present data related to: period 1 - before the program implementation; period 2 - with ID physician; and period 3 with inclusion of a pharmacist. Analysis was made by segmented regression of time series.

Results: After initiation of the program there was a significant reduction of consumption of all antimicrobials including carbapenems, fluoroquinolones, clindamycin, oxacillin, ampicillin/sulbactam and aminoglycosides; an increase in use of cephalosporins and piperacillin/tazobactam in period 2 compared to period 1. The pharmacist contributed to the consistent reduction in consumption of fluoroquinolones, clindamycin and ampicillin/sulbactam and in increase in total cephalosporins use in period 3. There was a reduction in rate of carbapenem resistant Pseudomonas spp.. (P=0.01), an increase in resistant of ceftazidime Pseudomonas spp. (P=0.005) and ceftazidime-resistant Klebsiella spp. (P<0.001). There was a significant reduction of 69% in hospital antibiotics costs.

Conclusions: The contribution of a trained pharmacist to the ASP permitted a more strict control of antibiotic use, resulting in a change in resistance profile and a reduction in antibiotic costs.