Pharmacists’ role in Antimicrobial Stewardship and relationship with antibiotic consumption in hospitals: an observational multicentre study

Abstract Objectives Worldwide, antimicrobial stewardship (AMS) teams include pharmacists, but their impact is little known. This study aimed to explore the relationship between pharmacists’ actions and antibiotic consumption. Methods Hospital pharmacists involved in the French antibiotic consumption surveillance network (ATB-Raisin) were invited to participate in a retrospective observational multicentre study. Collected data were: the previous year’s (2016) antibiotic consumption expressed in Daily Defined Dose per 1.000 Patient-Days, AMS measures, including pharmacist-specific actions and use of a computerized prescription order entry (CPOE) system. Associations between antibiotic consumption and AMS measures were assessed by linear regression, after adjustment for hospital activities. Results Annual data for 2016 from 77 hospitals (7,260,000 bed-days in 24,000 beds) were analysed. Pharmacists were involved in AMS programs in 73% of hospitals, and were the antibiotic advisor in 25%. Pharmaceutical review of prescriptions was organized in almost all hospitals (97%). The univariable analysis identified five measures associated with lower overall antibiotic consumption: CPOE use (if >80% of prescriptions; or 100%), pharmaceutical review (if >80% of beds; or 100%), and the antibiotic advisor being a pharmacist (p = 0.04, 0.004 and 0.003, respectively). In the multivariable analysis, two explanatory variables were significantly, independently associated with a lower overall antibiotic consumption: antibiotic advisor being a pharmacist and pharmaceutical review covering all beds (- 19.9% [-31.6%; -8.1%], p = 0.002 and - 18.3% [-34.0%; -2.6%], p = 0.03, respectively). Conclusions Antibiotic consumption was lower when the antibiotic advisor was a pharmacist and when the pharmaceutical team reviewed all prescriptions. These results highlight that actions initiated by pharmacists have a positive impact and should be supported.