Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 9;17(9):e0274324.
doi: 10.1371/journal.pone.0274324. eCollection 2022.

Influence of pharmacists and infection control teams or antimicrobial stewardship teams on the safety and efficacy of vancomycin: A Japanese administrative claims database study

Ryota Goto  1 , Yuichi Muraki  1 , Ryo Inose  1 , Yoshiki Kusama  2 , Akane Ono  3 , Ryuji Koizumi  3 , Masahiro Ishikane  3 , Norio Ohmagari  3
Affiliations

Influence of pharmacists and infection control teams or antimicrobial stewardship teams on the safety and efficacy of vancomycin: A Japanese administrative claims database study

Ryota Goto et al. PLoS One. .

Abstract

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) has a high mortality and requires effective treatment with anti-MRSA agents such as vancomycin (VCM). Management of the efficacy and safety of VCM has been implemented with the assignment of pharmacists in hospital wards and the establishment of teams related to infectious diseases. However, there are no reports evaluating the association between these factors and the efficacy and safety of VCM in large populations.

Methods: This study used the Japanese administrative claims database accumulated from 2010 to 2019. The population was divided into two groups, therapeutic drug monitoring (TDM) group and non-TDM group, and adjusted by propensity score matching. We performed multivariate logistic regression analysis to determine the influence of pharmacists and infection control teams or antimicrobial stewardship teams on acute kidney injury (AKI) and 30-day mortality.

Results: The total number of patients was 73 478 (TDM group, n = 55 269; non-TDM group, n = 18 209). After propensity score matching, 18 196 patients were matched in each group. Multivariate logistic regression analysis showed that pharmacological management for each patient contributed to the reduction of AKI (odds ratio [OR]: 0.812, 95% confidence interval [CI]: 0.723‒0.912) and 30-day mortality (OR: 0.538, 95% CI: 0.503‒0.575). However, the establishment of infectious disease associated team in facilities and the assignment of pharmacists in the hospital wards had no effect on AKI and 30-day mortality. In addition, TDM did not affect the reduction in AKI (OR: 1.061, 95% CI: 0.948‒1.187), but reduced 30-day mortality (OR: 0.873, 95% CI: 0.821‒0.929).

Conclusion: Pharmacologic management for individual patients, rather than assignment systems at facilities, is effective to reduce AKI and 30-day mortality with VCM administration.

PubMed Disclaimer

Conflict of interest statement

Yuichi Muraki received an honorarium for lecturing from Pfizer Japan Inc. The other authors have no conflicts of interest to declare.

Figures

Fig 1
Fig 1. Flow chart showing patient-selection process.
* Specific medication corresponds to drugs considered to be clinically eligible for TDM among those for whom treatment and management fees for specific drugs were calculated. Details are presented in S2 Table. VCM, vancomycin; TDM, therapeutic drug monitoring.
See this image and copyright information in PMC

References

    1. O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. 2016. [Cited 2022 July 3]. Available from: https://amr-review.org/sites/default/files/160525_Final%20paper_with%20c....
    1. Committee for the preparation of treatment guidelines for MRSA infections. Practical guidelines for the management and treatment of infections caused by MRSA, 2019 Edition [in Japanese]; 2019. [Cited 2022 March 2]. Available from: http://www.chemotherapy.or.jp/guideline/guideline_mrsa_2019.pdf.
    1. Tsuzuki S, Matsunaga N, Yahara K, Gu Y, Hayakawa K, Hirabayashi A, et al.. National trend of blood-stream infection attributable deaths caused by Staphylococcus aureus and Escherichia coli in Japan. J Infect Chemother. 2020;26: 367–371. doi: 10.1016/j.jiac.2019.10.017 - DOI - PubMed
    1. Goto R, Inose R, Kusama Y, Kawabe A, Ishii S, Ebisui A, et al.. Trends of the use of anti-methicillin-resistant Staphylococcus aureus agents in Japan based on sales data from 2006 to 2015. Biol Pharm Bull. 2020;43: 1906–1910. doi: 10.1248/bpb.b20-00605 - DOI - PubMed
    1. Wong-Beringer A, Joo J, Tse E, Beringer P. Vancomycin-associated nephrotoxicity: A critical appraisal of risk with high-dose therapy. Int J Antimicrob Agents. 2011;37: 95–101. doi: 10.1016/j.ijantimicag.2010.10.013 - DOI - PubMed

Publication types

MeSH terms