Study objective

The aim of this study was to evaluate the impact of pharmacist presence or pharmacist-led antimicrobial stewardship interventions on appropriate prescribing of antibiotics in the emergency department (ED).

Methods

Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were conducted. Studies describing the role of pharmacists and their association with antimicrobial stewardship in the ED were included. The comparator for pharmacist intervention was hours without a pharmacist present, preprotocol implementation, and nonpharmacist culture follow-up.

Results

In total, 24 studies (9,984 patients) were included in the qualitative synthesis, and 22 studies (5,791 patients) had data for the primary outcome and were included for the quantitative assessment (meta-analysis). Appropriate prescribing of antibiotics was more likely with pharmacist intervention (22 studies; odds ratio [OR], 3.47; 95% confidence interval [CI] 2.39 to 5.03), particularly among patients with pneumonia (5 studies; OR, 3.74; 95% CI 2.14 to 6.54) or urinary tract infection (4 studies; OR, 1.76; 95% CI 1.24 to 2.50). Time to culture review was similar with or without pharmacist intervention. Time to appropriate antibiotic was shorter with pharmacist intervention (mean difference, 18.9 hours; 95% CI 11.9 to 25.9; P<.001). Repeat ED visit for the same complaint was not significant (10 studies; OR, 0.65; 95% CI 0.39 to 1.10).

Conclusion

Pharmacist presence and pharmacist-led antimicrobial stewardship interventions appear to be effective for the appropriate prescribing of antibiotics in adult patients presenting to EDs with a variety of infectious syndromes.

中文翻译：

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药剂师主导的抗菌药物管理对急诊科适当抗生素处方的影响：系统评价和荟萃分析

学习目标

本研究的目的是评估药剂师在场或药剂师主导的抗菌药物管理干预措施对急诊科 (ED) 抗生素处方的影响。

方法

按照系统评价和荟萃分析指南的首选报告项目进行系统评价和荟萃分析。包括描述药剂师作用及其与急诊科抗菌药物管理关系的研究。药剂师干预的比较对象是没有药剂师在场的时间、方案前实施和非药剂师文化随访。

结果

总共有 24 项研究（9,984 名患者）被纳入定性综合，22 项研究（5,791 名患者）有主要结局数据，并被纳入定量评估（荟萃分析）。药剂师干预更有可能开具适当的抗生素处方（22 项研究；优势比 [OR]，3.47；95% 置信区间 [CI] 2.39 至 5.03），特别是在肺炎患者中（5 项研究；OR，3.74；95% CI 2.14 至 6.54）或尿路感染（4 项研究；OR，1.76；95% CI 1.24 至 2.50）。有或没有药剂师干预的文化审查时间相似。药剂师干预可缩短适当抗生素的时间（平均差，18.9 小时；95% CI 11.9 至 25.9；P<.001)。对同一主诉重复就诊并不显着（10 项研究；OR，0.65；95% CI 0.39 至 1.10）。

结论

药剂师的存在和药剂师主导的抗菌药物管理干预似乎对于在急诊室就诊的患有各种感染综合征的成年患者适当开具抗生素处方是有效的。