ISSN: 1859 - 2872
Optimizing colistin use with clinical pharmacist participation in intensive care units
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Abstract
Objective: To evaluate the impact of implementing a mandatory clinical pharmacy–led colistin stewardship program on prescribing practices and treatment outcomes in critically ill patients at a tertiary hospital in Vietnam. Methods: A quasi-experimental before-and-after study with a historical control group was conducted in intensive care units of a tertiary hospital. Patients receiving intravenous colistin during the historical control period (June 2022 - June 2023) were compared with those treated during the intervention period (March - July 2025), when mandatory pharmacist review was implemented; propensity score matching was used to balance baseline characteristics, and adherence to dosing protocols, antibiotic utilization, clinical/microbiological response, and acute kidney injury (AKI) during colistin treatment were assessed. Results: 42 patients received colistin during the intervention period; pharmacists provided 48 recommendations for 35 patients (83.3%), with an acceptance rate of 81.3%. After 1:1 matching (33 pairs), the intervention group showed higher protocol adherence for loading dose (81.3% vs. 61.1%), dosing interval (100% vs. 83.3%; p=0,042), and maintenance dose (69.7% vs. 42.4%; p=0.047); shorter colistin therapy (8 vs. 12 days; p=0.038) and overall antibiotic duration (21 vs. 29 days; p=0.008); and lower cumulative colistin dose (66 vs. 86 million international units; p=0.035). The incidence of acute kidney injury (AKI) during colistin treatment was lower in the intervention group than in the historical control group (18.2% vs. 36.0%), although the difference was not statistically significant (p = 0.207). Conclusion: Implementation of a colistin stewardship program with mandatory clinical pharmacist involvement was associated with improved dosing appropriateness and reduced antibiotic utilization in critically ill patients. These findings support the role of clinical pharmacists in hospital-based colistin stewardship.
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