ArticleAntimicrobial resistance and infection control2026
Practice model of unit-based clinical pharmacists' individualized daily antimicrobial use density monitoring report on antimicrobial stewardship in intensive care unit of a tertiary hospital in Guangxi, China: an interrupted time series analysis.
Article in Antimicrobial resistance and infection control, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHigh antimicrobial exposure and antimicrobial resistance in intensive care units (ICUs) remain major challenges to patient safety. This study evaluated whether a unit-based clinical pharmacist (UBCP) model supported by an individualized daily antimicrobial use density monitoring report (IAUD-RP) could improve antimicrobial stewardship in an ICU.
methodsThis single-center, retrospective, quasi-experimental study used interrupted time series analysis in a 12-bed ICU of a tertiary teaching hospital in Guangxi, China. Adult patients admitted between April 1, 2023, and October 31, 2025, were included. The intervention, initiated in August 2024, consisted of UBCP-led daily ward-wide screening, real-time risk stratification, and targeted pharmacist interventions using the individualized monitoring report. The primary outcome was antimicrobial use measured as defined daily doses (DDDs) per 100 patient-days. Secondary outcomes included average antimicrobial cost per hospitalization, multidrug-resistant organism healthcare-associated infection incidence density, clinical outcomes, and changes in specific antimicrobial agents or classes.
resultsA total of 657 patients were included (295 before, 362 after). UBCP recommendations achieved a 91.7% acceptance rate. Interrupted time series analysis showed a significant immediate reduction in antimicrobial use (level change, - 29.0 DDDs/100 patient-days; P = 0.038), following a significant pre-intervention upward trend (+ 2.5 per month; P = 0.005). Interrupted time series analysis showed a significant immediate reduction in average antimicrobial cost per hospitalization (level change, - 8304 CNY; P = 0.035), consistent with the crude reduction (25,568 to 14,926 CNY; P < 0.001). Total antimicrobial consumption decreased by 11.9%. Tigecycline, quinolones, and carbapenems decreased by 52.1%, 39.7%, and 15.8%, respectively, whereas WHO Access-group antibacterial agents increased by 67.8%. After excluding patients with indeterminate ('Others') outcomes, clinical failure was lower post-intervention (13.0% vs. 19.2%; adjusted OR 0.62, 95% CI 0.39-0.99; P = 0.045).
conclusionThe UBCP-led IAUD-RP model was associated with a significant and sustained reduction in antimicrobial use density, a directionally favorable change in antimicrobial cost and prescribing pattern, and a directionally favorable but non-confirmatory signal for reduced clinical failure.
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