Impact of clinical pharmacist-led antibiotic stewardship program on clinical outcomes in a tertiary referral hospital

Aims To evaluate the clinical outcomes of a clinical pharmacist-led antibiotic stewardship program (ASP). Methods and Results A prospective study of the ASP implementation, consisting of four broad-spectrum antibiotics (meropenem, imipenem, vancomycin and colistin) was performed in a tertiary referral, university-affiliated hospital in Tehran, Iran. Four hundred patients were included in the study via a simple randomisation method, over two six-month periods before (n = 200) and after (n = 200) ASP implementation. Clinical outcome, inappropriate antibiotic use, expenditure, and antibiotic resistance were assessed between two periods. A total of 349 patients were assessed after exclusion of patients who fulfilled exclusion criteria, of which 171 patients (49%) were included in the intervention period. Baseline characteristics between the two periods were similar except for mean severity score (3.64 +/- 2.80 pre vs. 4.29 +/- 2.88 post P < 0.03). There was a 17.67% decrease in inappropriate antibiotic use (P = 0.17). Length of stay (LOS) was shortened by 3.50 days (P = 0.93). Total cost was reduced by 21.58% and inappropriate cost was significantly declined from US$20 853.93 to US$14 482.76 (P = 0.04). Indeed, US$32.50 was saved per patient in six months. Mean days of therapy (DOT)/1000 patient-days and defined daily dose (DDD)/1000 patient-days were reduced by 6.90% and 12.77%, respectively (P > 0.05). Furthermore, antibiotic resistance was decreased by 33.62% over this short period. Conclusion These results demonstrate that the potential role of the clinical pharmacist in implementing an ASP, and the resultant rational use of antibiotics, can provide considerable clinical and economic benefits.