Clinical Evaluation of Pharmacist Interventions in Patients Treated with Anti-methicillin-Resistant Staphylococcus aureus Agents in a Hematological Ward

• Published in: Biological & pharmaceutical bulletin 2016/02/01, Vol.39(2), pp.295-300
• Main Authors: Okada, Naoto, Fushitani, Shuji, Azuma, Momoyo, Nakamura, Shingen, Nakamura, Toshimi, Teraoka, Kazuhiko, Watanabe, Hiroyoshi, Abe, Masahiro, Kawazoe, Kazuyoshi, Ishizawa, Keisuke
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; arbekacin; Drug Monitoring - methods; Drug Monitoring - standards; Drug Utilization; Female; Hospitals; Humans; Male; Methicillin-Resistant Staphylococcus aureus - drug effects; Middle Aged; pharmacist intervention; Pharmacists; Retrospective Studies; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcus aureus; teicoplanin; therapeutic drug monitoring; vancomycin; Young Adult
• ISSN: 0918-6158; 1347-5215
• DOI: 10.1248/bpb.b15-00774

The therapeutic effects of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents, vancomycin (VCM), teicoplanin (TEIC), and arbekacin (ABK), depend on their concentrations in blood. Therefore, therapeutic drug monitoring (TDM) is important when these antibiotics are used. In the hematological ward at Tokushima University Hospital, pharmacists have ordered the measurement of blood VCM, TEIC, and ABK concentrations to promote the use of TDM in accordance with an agreed protocol since 2013. Moreover, the infection control team includes several medical disciplines and has advised on the optimal treatment using VCM, TEIC, and ABK since 2013. This study aimed to investigate the clinical effectiveness of these pharmacist interventions. We retrospectively studied 145 cases in which patients were treated with VCM, TEIC, or ABK between January 2012 and December 2013 in the hematological ward at Tokushima University Hospital. The patients were divided into a control group (71 cases) and an intervention group (74 cases), and their clinical outcomes were compared. The rate of achievement of effective drug concentrations significantly increased in the intervention group (74%), compared to the rate in the control group (55%). Moreover, univariate and multivariate Cox proportional hazard regression revealed that pharmacist intervention and appropriate concentrations of anti-MRSA agents were independent factors associated with reduced hospitalization periods in patients with lymphoma. Our study revealed that proactive pharmacist intervention may improve the therapeutic effect of anti-MRSA agents in hematology ward patients.