医師主導と薬剤師主導の血液培養陽性患者への介入効果の比較

抄録

At Tokyo’s Ebara Hospital, infectious disease physicians have led interventions among patients with positive blood cultures. However, pharmacists began to lead such interventions from April 2020 triggered by the coronavirus disease 2019 (COVID-19) pandemic and the reduction in the number of infectious disease physicians. Therefore, this study aims to compare the effects of physician-led and pharmacist-led interventions among patients with positive blood cultures. We divided the study period into a physician-led period (April 2019 to October 2019) and pharmacist-led period (April 2020 to October 2020). We retrospectively investigated the patients’ characteristics, number of blood cultures, blood culture positivity rates, sources of infections, and the types of bacteria detected. We set the primary endpoints as a 30-day mortality and in-hospital mortality, and the secondary endpoint as days of therapy (DOT) per 1,000 patients with broad-spectrum antimicrobial agents, anti-MRSA agents, and all intravenous antimicrobial agents. During the study period, 68 and 63 patients received interventions during the physician-led and pharmacist-led periods, respectively. During the pharmacist-led period, malignancies and blood culture positivity rates were found to be high in patients, and the number of DOT with anti-MRSA agents increased. However, no significant differences were observed in the 30-day mortality and in-hospital mortality. The study results demonstrated that pharmacist-led interventions may not be significantly different from physician-led interventions implemented among patients with positive blood cultures. However, as the study was conducted under the special situation of the COVID-19 pandemic, the effect of these conditions must be considered.