目的： 建立感染專科臨床藥事照護模式，經臨床藥師介入carbapenems 類抗生素合理使用，以降低antipseudomonal carbapenems (imipenem 及meropenem) 的耗用量達10% 以上及降低藥費。

方法： 建立感染專科臨床藥事照護模式，由ICU 臨床藥師與感染專科臨床藥師執行臨床藥事服務，與醫師共同查房、提供抗生素藥品諮詢及治療評估、病人用藥建議、不良反應評估等。經由臨床藥事服務過程評估病患所有使用之抗生素之合理性 ( 含carbapenems) 並提供醫師適當之用藥建議。臨床藥師於住院病人後線抗生素處方開立後24 小時內，評估該病人所有抗生素使用適當性並記錄分析carbapenems 類抗生素耗用量與藥費。

結果： 經過8 個月的導入感染專科臨床藥事照護模式，imipenem 總耗用量減少17%、Meropenem 減少18%。carbapenems 類抗生素總耗用量減少5%。carbapenems 類抗生素總藥費減少12%。藥師介入carbapenems 類抗生素合理性使用共248 件，其中carbapenem 抗生素之不合理使用共59 件，醫師接受率達88%。介入原因包括抗生素選用不適當44%、需劑量調整29%、輸液相容性問題19%、藥物交互作用3%、藥物不良反應3% 及未做細菌培養2%。

結論： 抗生素管理計畫中導入「感染專科臨床藥事照護模式」能成功減少anti-pseudomonal carbapenems 類抗生素 (imipenem 及meropenem) 的耗用量與減少carbapenems 類抗生素之總藥費。此感染專科臨床藥事照護模式適合落實於平日的臨床藥事照護當中。
 

Background: Acinetobacter baumannii complex infections are associated with high morbidity, mortality and cost. Increased use of anti-pseudomonal carbapenems (imipenem, meropenem) was associated with increased rates of carbapenem-resistant acinetobacter baumanni (CRAB) isolates.Pharmacist intervention can play a major role in the appropriate use of antibiotics.Objectives: To evaluate the impact of an infectious disease pharmaceutical care model (IDPCM) in an antibiotic stewardship program on anti-pseudomonal arbapenem consumption and expenditure.

Methods: Training of pharmacists began in August 2013. The IDPCM was implemented in January 2014 which included intensive care unit (ICU) pharmaceutical care, infectious disease pharmaceutical care and evaluation of antibiotic prescriptions including carbapenems. In ward rounds, clinical pharmacists presented cases with the need for antimicrobial changes and complicated patients on broad-spectrum antimicrobials. Pharmacists provided suggestions for changes to antibiotic use to doctors. Comparison of carbapenem consumption and cost pre- and post-implementationof the IDPCM were conducted between the periods January to August 2013 and 2014.

Results: Four pharmacists completed training and participated in an antibiotic stewardship program.Imipenem, meropenem and total carbapenems consumption decreased 17%, 18% and 5%respectively. Total carbapenem expenditure declined by 12%. 248 interventions were made by clinical pharmacists (including 59 carbapenem interventions) during the 8-month study period.The doctors’ acceptance rate was 88%. The most common interventions were inappropriate antibiotic selection 44%, dose adjustment 29%, and IV incompatibility 19%.

Conclusion: Implementation of IDPCM in an antibiotic stewardship program can decrease the carbapenem consumption and decrease total carbapenem expenditure. This pharmaceutical care model could be implemented into daily practice.