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Published on 29 April 2009

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Hospital-acquired infection: challenges and opportunities

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There is evidence that antibiotics predispose patients to MRSA and C difficile. Hospital pharmacists are ideally placed to manage antibiotics effectively and so reduce hospital-acquired infections

Ray Fitzpatrick, Consultant Editor

As usual, hospital pharmacists will find something of interest in this edition of HPE, since once again it carries a wide variety of articles. Topics range from the pharmaceutical stability of 5-fluorouracil and sodium folinate admixtures through to the application of new medicines such as sorafenib in hepatocellular cancer and a review of a new antifungal agent, micafungin. Treatment of infections also features in the report on the UKCPA Autumn symposium in November of last year where a number of presentations focused on prudent use of antibiotics.

The role of the hospital pharmacist in the management of antibiotics is worthy of further comment. The emergence of resistance to antibiotics has been a concern since before the turn of the millennium. Indeed, the monitoring of antibiotic use is the focus of a European-wide initiative. Although the driver for prudent use of antibiotics has been concern over resistance, there is now evidence to indicate that some antibiotics, particularly broad-spectrum cephalosporins and fluoroquinolones, predispose patients to Clostridium difficile. Furthermore, work presented at the UKCPA Autumn symposium also suggests a link between third-generation cephalosporins and hospital-acquired MRSA. Both these hospital-acquired infections carry a high mortality rate, particularly in the elderly. Therefore, reducing their incidence can have a significant impact on hospital mortality rates and length of stay.

While reducing hospital-acquired infections requires a range of measures, including effective hand hygiene and deep cleaning of wards, careful management of antibiotics is now recognised as also making an important contribution. Clearly, hospital pharmacists, who are at the centre of the medicines management agenda, have an important role to play in the effective management of antibiotics, and ultimately hospital-acquired infections.

Several years ago the UK government invested £12m into a three-year project specifically to fund pharmacy initiatives to improve antibiotic use. Most of this money was used by hospitals to employ specialist antibiotic pharmacists, and the fact that most hospitals in the UK now have an antibiotic pharmacist, long after the central funding has ceased, is testament to the value individual organisations place on these posts. Furthermore, these pharmacists are now starting to publish and present on specific initiatives associated with effective antibiotic management, as demonstrated at the UKCPA symposium.

Coincidentally, at the ESCP meeting in Croatia in October 2008, which is also featured in this edition of HPE, Professor Steven Simoens reported that many studies have shown positive benefits of pharmacy services due to direct savings or estimated cost avoidance arising from reduced adverse drug events (ADEs) or decreased length of stay in hospital. Professor Simoens’ comments, together with the role antibiotics can play in predisposing patients to the growing problem of hospital-acquired infections, clearly signal an area where we, as hospital pharmacists, should be focusing our efforts. In my own hospital, concerted action to reduce MRSA and C difficile, which includes close monitoring and control of “high-risk” antibiotics, has resulted in real reductions in mortality and length of stay.

In the UK we have gone down the route of employing pharmacists with specific responsibility for effective management of antibiotics who can educate pharmacy, medical and nursing staff, and who, working closely with consultant microbiologists, act as champions for better use of antibiotics. However, promoting prudent use of antibiotics is every pharmacist’s responsibility, with significant benefits for patients and hospitals. While hospital-acquired infections are a challenge, they provide an opportunity for us to demonstrate our worth. However, if patients across Europe are to benefit from better management of antibiotics, we must share the results of local initiatives, and publishing in HPE is an excellent way to achieve this.



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