Journal of Korean Society of Health-System Pharmacists (병원약사회지)

The Korean Society of Health-System Pharmacists (한국병원약사회)
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Evaluation of the Appropriateness of Empirical Antibiotic Prescription after Implementation of Antibiotic Treatment Guidelines for Pneumonia in a Hospital

원내 폐렴 진료 지침 수립 후 경험 항생제 선택의 적절성 평가

  • Kang, Jiyoung (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Kim, Hyungsook (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Jeong, Youngmi (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Namgung, Hyungwook (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Lee, Eunsook (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Lee, Euni (College of Pharmacy, Seoul National University) ;
  • Hwang, Joohee (Geriatric Center, Seoul National University Bundang Hospital) ;
  • Song, Kyoungho (Geriatric Center, Seoul National University Bundang Hospital) ;
  • Kim, Eusuk (Geriatric Center, Seoul National University Bundang Hospital) ;
  • Kim, Hongbin (Geriatric Center, Seoul National University Bundang Hospital)
  • 강지영 (분당서울대학교병원 약제부) ;
  • 김형숙 (분당서울대학교병원 약제부) ;
  • 정영미 (분당서울대학교병원 약제부) ;
  • 남궁형욱 (분당서울대학교병원 약제부) ;
  • 이은숙 (분당서울대학교병원 약제부) ;
  • 김은경 (서울대학교 약학대학) ;
  • 황주희 (분당서울대학교병원 감염내과) ;
  • 송경호 (분당서울대학교병원 감염내과) ;
  • 김의석 (분당서울대학교병원 감염내과) ;
  • 김홍빈 (분당서울대학교병원 감염내과)
  • Received : 2017.09.12
  • Accepted : 2018.09.14
  • Published : 2018.12.31
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Abstract

Background : The Antimicrobial Stewardship Program promotes interdisciplinary interventions and targeted recommendations for the proper utilization of antibiotics. In particular, the aim of the program is to avoid indiscriminate use of broad-spectrum antibiotics based on the documented literature on the significant impact of unsystematic usage of antibiotics on the distribution of antibiotic-resistant microorganisms. To improve the care process for pneumonia treatment using antimicrobial agents, institution-level guidelines were established and disseminated at the Seoul National University Bundang Hospital in April 2016. In this study, we evaluated changes in the physicians'antibiotic prescribing patterns both before-and after-the implementation of the guidelines. Methods : The electronic medical records of inpatients who were prescribed with one or more antibiotics in May 2014 (Group A) and May 2016 (Group B) were reviewed. Data on demographic characteristics, clinical outcomes, and antibiotic prescriptions were collected and the prescription records were compared both before- and after- the implementation of the guidelines. Results : A total of 180 patients were included in the study: 77 patients in group A and 103 patients in group B. The baseline characteristics of the patients were not significantly different between the two groups. Community-acquired pneumonia was the most common diagnosis in both the groups and the difference was not significant (68.8% vs. 67.9%; p=0.67). The type of antibiotic prescriptions used for empirical treatment was not different between the two groups. The most commonly prescribed empirical antibiotics were cephalosporins, with no significant difference (p=0.31). One of the most inappropriately used antibiotics was piperacillin/tazobactam and the rate of prescription was similar in both the groups (p=0.68). The rates of appropriate empirical selection of antibiotics remained unaltered between the two groups (67.5% vs. 71.8%; p=0.53). Conclusions : Implementation of the guidelines only exhibited no significant effect on the antibiotic prescribing patterns of physicians for the treatment of pneumonia. To improve the adequate use of empiric antibiotics, more active interventions and closer monitoring of the feedbacks should be additionally considered and evaluated in future studies.

Keywords

Acknowledgement

Supported by : 한국보건산업진흥원

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