Pharmacists Made Fewer Antimicrobial Stewardship Interventions After Working Weekends

As dangerous pathogens develop resistance to frequently used antibiotics, it is essential employ antimicrobial stewardship practices to monitor and limit antibiotics used. Critical care pharmacists play a crucial role in implementing antimicrobial stewardship in intensive care units (ICU).

A study presented at the 51st Critical Care Congress examined antimicrobial stewardship interventions made by post-graduate year 2 critical care (PYG2CC) pharmacy residents during weekend shifts. The study determined whether interventions made on the weekends affected the type and number of interventions made on Mondays.

The retrospective study included critically ill adult patients from 9 ICUs. Patients were hospitalized from August 2020-May 2021 at an academic medical center. The investigators documented antimicrobial management interventions made by critical care clinical pharmacists and PGY2CC residents for 39 Mondays.

The results showed that more than half of the interventions PGY2CC residents made during their weekend shifts were related to antimicrobial stewardship practices. Of these, 59% involved therapeutic drug monitoring and dose adjustments. Notably, fewer antimicrobial stewardship interventions were made by the critical care pharmacists on the Mondays directly after a PGY2CC resident weekend shift (average of 9). Conversely, PGY2CC residents made more antimicrobial stewardship interventions on the Mondays following weekends they did not work (average of 14).

Additionally, fewer dose adjustments for renal impairments occurred on Mondays immediately following weekends residents worked (average of 4 versus 2). The investigators found no significant difference in de-escalation, optimization of pharmacokinetics/pharmacodynamics, or therapeutic drug monitoring on Mondays after the pharmacists worked versus did not work.

The study authors concluded that PGY2CC residents frequently implement important interventions outside of typical working hours. To ensure antimicrobial stewardship remains a priority, the finding that critical care pharmacist made fewer interventions on the Monday after working a weekend shift should be made known to hospital staff and administrators.

The study, “Characterization of Antimicrobial Stewardship Interventions Made by Pharmacists in ICU patients,” was presented on April 18, 2022, during the 51st Critical Care Congress.