Transitioning from Pharmacist-led to Informatics-Integrated Antimicrobial Stewardship: An Interrupted Time Series...

This study aimed to assess and compare the effects of two Antimicrobial Management System (AMS) phases in a tertiary hospital in China on the rational utilization of antimicrobial drugs: Pharmacist-led Manual Intervention (Phase I) and the Addition of Informatics-based Clinical Medication Pathway Intervention (Phase II). An interrupted time series study was adopted to analyze the immediate level changes and long-term trend shifts of multiple indicators covering antimicrobial use, quality control, nosocomial infection, and clinical treatment efficiency after the interventions. After the intervention, the average monthly defined daily doses (DDDs) of antibiotics decreased by 6.06% (P=0.029) and the average monthly cost decreased by 38.59% (P<0.001). The structure of drug use was significantly optimized: DDDs for intravenous drug use decreased by 20.04%, while oral drug use increased by 22.10%. The DDDs of restricted antibiotics decreased by 35.14%, and that of unrestricted antibiotics increased by 33.02%. The ITS analysis showed that the combined approach in Phase II provided additional immediate reductions in antimicrobial use intensity and expenditure proportions beyond the initial Phase I implementation. In terms of clinical outcomes, the nosocomial infection rate and the positive culture rate of carbapenem-resistant bacteria were significantly decreased (P<0.05). The 24-hour antibiotic withdrawal rate for Class I surgical incisions was significantly increased from 8.09% to 41.62% (P<0.001), and the average treatment duration of infectious diseases was shortened. The AMS strategy led by clinical pharmacists, especially when integrated with the intelligent clinical medication pathway system, was associated with a significant reduction in the overall drug consumption and cost, optimized the medication structure, and improved key clinical outcomes.