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Background <p>Antimicrobial stewardship programs (ASPs) are recommended to optimize antibiotic use in intensive care units (ICUs); however, many institutions lack infectious disease specialists and pharmacy expertise for full implementation. The COVID-19 pandemic further disrupted conventional stewardship. While tele-stewardship models have shown promise, evidence for hybrid programs operating without infectious disease specialist leadership remains limited, particularly outside high-income countries. We developed a hybrid ASP (hASP) collaboratively led by an on-site intensivist and an off-site faculty clinical pharmacist to reduce inappropriate antibiotic use and improve outcomes in a resource-constrained ICU.</p> Methods <p>This prospective, single-center, pre-post study was conducted in the medical ICU of a 733-bed university teaching hospital in Seoul, South Korea. The pre-intervention period (August to October 2017) with no ASP was compared with the post-intervention period (August to October 2020) following hASP implementation. Stewardship activities were primarily performed off-site by trained clinical pharmacists via secured messaging, telephone, and video conferencing, with on-site rounds every other weekday. Key outcomes were inappropriate antibiotic prescriptions per 100 patient-days, 30-day all-cause mortality, ICU length of stay, preventable adverse drug events, and days of therapy, assessed using Delphi-derived appropriateness criteria.</p> Results <p>Thirty-three and 37 admissions were analyzed (364 and 251 patient-days). On-site activities were limited to three hours daily or less. Inappropriate prescriptions declined from 83.8 to 20.7 per 100 patient-days (<i>p</i> &lt; 0.001), ICU length of stay from 14 to 6 days (<i>p</i> &lt; 0.05), and preventable adverse drug events from 4.4 to 2.8 per 100 patient-days (<i>p</i> &lt; 0.05). Thirty-day all-cause mortality was comparable (24.2% vs. 24.3%). The most frequent pharmacist interventions were dose optimization (47.8%) and antimicrobial discontinuation (40.6%), with an overall acceptance rate of 62.3%. Days of therapy for broad-spectrum antibiotics targeting multidrug-resistant organisms declined while those for narrower-spectrum agents increased, suggesting a shift toward targeted therapy.</p> Conclusion <p>The hASP, collaboratively led by an intensivist and a faculty clinical pharmacist with off-site pharmacist-led interventions via virtual communication, significantly reduced inappropriate prescribing, ICU length of stay, and preventable adverse drug events. Hybrid stewardship models may serve as a feasible alternative to on-site programs in resource-limited settings.</p>

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Clinical impact of a multidisciplinary remote-based hybrid antibiotic stewardship program in critically ill patients during COVID-19 pandemic in Korea: a prospective pilot implementation study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月6日

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  • Suhyun Lee,
  • Soyun Park,
  • Min Gu Shin,
  • Hyeong Geun Jo,
  • Kyeoul Jeong,
  • Ji-Eun Yoon,
  • Kyong Nam Ye,
  • Yeo Jin Choi,
  • Minseo Choe,
  • Seungwon Yang,
  • Pureunnarae Kang,
  • Jung-Tae Kim,
  • Sung Wook Kang,
  • Eun Kyoung Chung

摘要

Background

Antimicrobial stewardship programs (ASPs) are recommended to optimize antibiotic use in intensive care units (ICUs); however, many institutions lack infectious disease specialists and pharmacy expertise for full implementation. The COVID-19 pandemic further disrupted conventional stewardship. While tele-stewardship models have shown promise, evidence for hybrid programs operating without infectious disease specialist leadership remains limited, particularly outside high-income countries. We developed a hybrid ASP (hASP) collaboratively led by an on-site intensivist and an off-site faculty clinical pharmacist to reduce inappropriate antibiotic use and improve outcomes in a resource-constrained ICU.

Methods

This prospective, single-center, pre-post study was conducted in the medical ICU of a 733-bed university teaching hospital in Seoul, South Korea. The pre-intervention period (August to October 2017) with no ASP was compared with the post-intervention period (August to October 2020) following hASP implementation. Stewardship activities were primarily performed off-site by trained clinical pharmacists via secured messaging, telephone, and video conferencing, with on-site rounds every other weekday. Key outcomes were inappropriate antibiotic prescriptions per 100 patient-days, 30-day all-cause mortality, ICU length of stay, preventable adverse drug events, and days of therapy, assessed using Delphi-derived appropriateness criteria.

Results

Thirty-three and 37 admissions were analyzed (364 and 251 patient-days). On-site activities were limited to three hours daily or less. Inappropriate prescriptions declined from 83.8 to 20.7 per 100 patient-days (p < 0.001), ICU length of stay from 14 to 6 days (p < 0.05), and preventable adverse drug events from 4.4 to 2.8 per 100 patient-days (p < 0.05). Thirty-day all-cause mortality was comparable (24.2% vs. 24.3%). The most frequent pharmacist interventions were dose optimization (47.8%) and antimicrobial discontinuation (40.6%), with an overall acceptance rate of 62.3%. Days of therapy for broad-spectrum antibiotics targeting multidrug-resistant organisms declined while those for narrower-spectrum agents increased, suggesting a shift toward targeted therapy.

Conclusion

The hASP, collaboratively led by an intensivist and a faculty clinical pharmacist with off-site pharmacist-led interventions via virtual communication, significantly reduced inappropriate prescribing, ICU length of stay, and preventable adverse drug events. Hybrid stewardship models may serve as a feasible alternative to on-site programs in resource-limited settings.