Evaluation of the Impact of Pharmacist-Led Communication of the Clinical Pulmonary Infection Score (CPIS) on Antibiotic Prescribing in the Intensive Care Unit – A Pilot Study

Abstract

Abstract Background: Overprescribing of antibiotics for nosocomial pneumonia in the intensive care unit (ICU) is a prevalent issue for antimicrobial stewardship programs (ASP). Discontinuation of antibiotics based on a low Clinical Pulmonary Infection Score (CPIS) on day 3 of therapy is associated with decreased antibiotic days and antimicrobial resistance. However, the impact of a pharmacist-led CPIS initiative is unknown. Objectives: The primary objective was to assess feasibility of a pharmacist-led CPIS initiative. Secondary objectives included determining impact on antibiotic prescribing and patient-important outcomes, and discerning prescriber rationale for antibiotic continuation in patients eligible for discontinuation. Methods: This was a prospective, interventional pilot study of ICU patients treated for nosocomial pneumonia over eight weeks. Pharmacists suggested antibiotic discontinuation on Day 3 of treatment for patients with CPIS ≤6 on Days 1 and 3 of therapy. Physician rationale for continuing antibiotics beyond Day 3 for these patients was recorded. Comparisons were drawn between the study period and data collected previously under auspices of ASP, without pharmacist intervention. Results: During this study period, eleven patients met the inclusion criteria, with six patients eligible for discontinuation. Data was collected from 12 patients during the ASP period. Two discontinuations occurred during the study period, in comparison with none during ASP data collection. There were significantly fewer mean ICU antibiotic days during the study period (11.17 days; 95% CI 4.41-17.93) than the ASP period (22.67 days; 95% CI 19.03-26.31). Physician rationale for antibiotic continuation included positive sputum cultures and extra-pulmonary infections. Barriers identified during the study included prescriber unfamiliarity with the CPIS and pharmacist unavailability on weekends. Conclusions: The pilot study demonstrated feasibility of a pharmacist-led CPIS intervention and identified barriers that may have affected its impact. Pharmacist intervention was associated with significant reduction in mean antibiotic days. Larger studies would provide further insight into potential impacts of pharmacist-led CPIS interventions.