General anesthetics have various effects such as anesthetic effects, organ protective effects against ischemia-reperfusion injury/inflammatory and onco-/anti-cancer effects. General anesthetics have been revealed to change about 1.5% of gene expressions and to control biological activity. But a part of gene expression changes induced by general anesthesia have been found not to be associated with protein expression changes. Since the discovery of post-translational modification by microRNAs (miRNAs), it has become clear that intracellular signaling and cell-to-cell communication are complicated mechanisms. miRNAs are, in turn, expected to influence the effects of general anesthesia. Previous reports revealed that the miRNA expression changes induced by general anesthetics 1) depend on the organ, and 2) depend on the anesthetics. It has also been shown that general anesthetics can provide renal and lung protection via miRNAs. Furthermore, miRNA is one of the treatment targets that can be expected to be applied in perioperative management. However, to date, only a few studies have been published in the field of perioperative management via miRNA. Because post-translational modification by miRNAs involves a complicated mechanism, it is necessary to confirm the effect of general anesthetics via miRNAs in clinical research. In future, accumulation of further knowledge might contribute to selecting the optimal anesthesia method in consideration of each patient's comorbidities.
Efficient antimicrobial stewardship (AS) effectively involves monitoring targets for infectious disease treatments, including the use of antimicrobial agents, infectious disease test results, special populations, and special pathological conditions. Many institutions have collaborated with antimicrobial stewardship teams (ASTs) to evaluate antibiotic use and infectious disease test results and have reported their usefulness. Although the intensive care unit (ICU) is considered an intervention for special populations, AST intervention alone in the ICU is insufficient, and no usefulness of AST has been reported to date. This study investigated the patient mortality rate and susceptibility to antimicrobial and antifungal drugs in the ICU before and after a pharmacist was assigned to actively perform AS.
All study patients had tested positive for bacterial infection in blood cultures. Those treated during the period when no pharmacist was assigned to the ICU (June-November 2013) were used as the control group, and those treated during the period when a pharmacist was assigned to the ICU and actively performed AS (June-November 2017) made up the active intervention group. The primary endpoints were ICU death and death within 30 days of ICU admission. The secondary endpoints were the intervention status of antibacterial and antifungal agents, days of therapy (DOT) in the ICU, and the susceptibility of each antimicrobial agent to Pseudomonas aeruginosa.
ICU deaths occurred in 45% (5/11) and 28% (5/18) of patients in the control and intervention groups, respectively (P=0.33). The 30-day mortality rates were 44% (4/9) and 33% (4/12) in the control and intervention groups, respectively (P=0.64). Regarding the secondary endpoint, pharmacists confirmed 90% antibiotic usage and intervened in the treatment of 18% of the patients. The number of interventions accepted was 196, and the number of non-interventions was 13. Tazobactam/piperacillin (TAZ/PIPC) increased DOT in the ICU, whereas quinolones and carbapenems decreased DOT in the ICU. The susceptibility of Pseudomonas aeruginosa to ceftazidime and TAZ/PIPC decreased, while its susceptibility to quinolone and carbapenem antibiotics increased.
Although there were no statistically significant differences between the groups in terms of ICU deaths or death within 30 days of ICU admission, effective AS can be performed by a ward pharmacist with knowledge of the pathologies of the infectious disease patients. We suggest that the resistance of Pseudomonas aeruginosa to each antibiotic can be prevented with the intervention of a ward pharmacist.