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Abstract：
Although specialized pharmacists have been suggested to be essential members of antimicrobial stewardship programs (ASPs), not all hospitals in Korea operate ASPs with pharmacists involved. We aimed to evaluate the association of involvement of clinical pharmacists as team members of multidisciplinary ASPs with the incidence of antimicrobial-related adverse drug events (ADEs). Five tertiary teaching hospitals participated in this retrospective cohort study. At each participating hospital, we randomly selected 1000 participants among patients who had received systemic antimicrobial agents for more than one day during the first quarter of 2017. We investigated five categories of antimicrobial-related ADEs: allergic reactions, hematologic toxicity, nephrotoxicity, hepatotoxicity, and antimicrobial-related diarrhea. Multivariate logistic regression analysis was used to evaluate the potential impact of pharmacist involvement in ASPs on the incidence of ADEs. A total of 1195 antimicrobial-related ADEs occurred in 618 (12.4%) of the 4995 patients included in the analysis. The overall rate of ADE occurrence was 17.4 per 1000 patient days. Hospitals operating ASPs with pharmacists showed significantly lower AE incidence proportions than other hospitals (8.9% vs. 14.7%; p < 0.001). Multidisciplinary ASPs that included clinical pharmacists reduced the risk of antimicrobial-related ADEs by 38% (adjusted odds ratio 0.62; 95% confidence interval 0.50-0.77). Our results suggest that the active involvement of clinical pharmacists in multidisciplinary ASPs may contribute to reduce the incidence of antimicrobial-related ADEs in hospitalized patients.
摘要：
尽管专业药剂师被认为是抗菌药物管理计划（ASP）的重要成员，并非所有的医院在韩国都有药剂师参与的ASP。我们旨在评估临床药师作为多学科ASP的团队成员参与与抗菌药物相关不良事件（ADE）发生率的关系。五家三级教学医院参加了这项回顾性队列研究。在每个参与的医院，我们从2017年第一季度接受系统性抗菌药物治疗超过1天的患者中随机选择了1000名参与者.我们调查了五类抗菌相关的ADE：过敏反应，血液学毒性，肾毒性，肝毒性，和抗菌相关的腹泻。多因素logistic回归分析用于评估药师参与ASP对ADE发生率的潜在影响。在纳入分析的4995例患者中，618例（12.4%）发生了1195例抗微生物相关的ADE。ADE的总发生率为17.4/1000患者天。与药剂师一起进行ASP的医院显示，AE发生率明显低于其他医院（8.9％vs.14.7%；p<0.001）。包括临床药师在内的多学科ASP将抗菌药物相关ADE的风险降低了38％（调整后比值比0.62；95％置信区间0.50-0.77）。我们的结果表明，临床药师积极参与多学科ASP可能有助于降低住院患者抗菌药物相关ADE的发生率。
