Hiệu quả của việc duyệt sử dụng kháng sinh meropenem và colistin tại Bệnh viện Đại học Y Dược Thành phố Hồ Chí Minh

Abstract

Objective: Authorization of restricted antibiotics including meropenem and colistin is one of the most important strategies in the Antibiotic Stewarship Programs (ASP) in clinical settings. Prior authorization of meropenem and colistin has been implemented at University Medical Center, Ho Chi Minh City (UMC HCMC) since April 2021 by clinical pharmacists in the ASP core team. This study aims to evaluate the impact of prior authorization of meropenem and colistin at UMC HCMC. Subject and method: A before - after descriptive cross-sectional study was conducted on 695 patients indicated with either meropenem or colistin at UMC HCMC, including 386 patients in period 1 (October 2020) and 309 patients in period 2 (October 2022). Changes in length of treatment with meropenem or colistin, treatment success, consumption and cost of these antibiotics were the main outcomes in assessing the impact of intervention. Result: The median age of the patients in periods 1 and 2 were 70 (58, 82) and 66 (53, 77), respectively. There was an in increase in the proportions of patients indicated for microbiology testing (95.5% vs 90.4%) and proper timing of specimen collection in period 2 compared to period 1 (90.2% vs 73.4%). Compared to period 1, shorter treatment duration with colistin (11.0 days vs 13.5 days, p=0.047), lower of consumption of colistin (4.9 vs 8.1 DDD/100 bed-days) and lower total cost of colistin (16965.0 (5713.0-38691.0) thousands VND vs 42224.0 (17813.3-58529.3) thousands VND, p=0.002) were observed in period 2. No significant difference was observed in either treatment duration with meropenem or total cost of meropenem between the two periods. Higher treatment success rate (90.3% vs 84.7%, p=0.029) was recorded in period 2. Prior authorization of antibiotics was one factor statistically associated with the likelihood of treatment success (OR = 1.984, 95% CI: 1.025-3.841, p=0.042). Conclusion: This study provided the proof of impact of the ASP, especilly clinical pharmacy intervention on the use of restricted antibiotics.