Why was it done?

Before this initiative, surgical antibiotic prophylaxis (SAP) monitoring was paper-based and mainly handled by nursing staff, with little pharmacist or surgeon engagement. Entries were often incomplete or inaccurate, with frequent confusion between prophylactic and therapeutic use. Critical parameters—timing, duration, and patient-specific factors—were inconsistently recorded, and data were rarely analysed, so protocol compliance went unmonitored. Consequently, surgeons paid limited attention to guideline adherence or to the contribution of suboptimal prophylaxis to antimicrobial resistance. These gaps exposed patients to unnecessary antibiotic exposure and avoidable infection risk. The project was therefore launched to create a reliable, accountable monitoring process that would improve data quality and enable systematic feedback and stewardship.

What was done?

A clinical pharmacist-led, electronic monitoring system for SAP was developed. A comprehensive data-capture form (demographics, surgery type and duration, wound class, antibiotic choice, dose, timing, and duration) was designed after benchmarking similar tools and implemented in the hospital information system (HIS). Clinical pharmacists reviewed all SAP entries, verified completeness before discharge, and generated reports shared with the Infection Control Committee and hospital management to support data-driven interventions.

How was it done?

A multidisciplinary team of pharmacists, infection control experts, IT staff, and surgeons collaborated under hospital leadership to design and implement the process. All patients undergoing surgery and receiving SAP were monitored by trained pharmacists in the wards, and data entries were completed before discharge to ensure accuracy. The collected information was analysed by clinical pharmacists, and discrepancies between clinical practice and established protocols were flagged. The Infection Control Team, in collaboration with hospital management, provided feedback to surgeons and developed targeted training programmes where needed. Initial barriers—limited familiarity with digital forms and resistance to workflow changes—were overcome through structured training, ongoing communication, and continuous on-ward support.

What has been achieved?

Documentation completeness and accuracy improved markedly, enabling routine compliance assessment across antibiotic choice, dose, timing, and duration. Analysis identified delays in administration; corrective actions, education, and protocol updates followed. Surgeon awareness of correct timing increased, and the pharmacist’s role in antimicrobial stewardship was strengthened.

What next?

Next steps include embedding the revised SAP protocol across all surgical units, regular audits, and continued pharmacist-led monitoring to sustain improvements. By integrating SAP monitoring data with patient readmission data for surgical site infections, we aim to evaluate whether improved documentation, training, and protocol revision lead to measurable reductions in infection-related readmissions. The model is effective, scalable, and transferable to other hospitals. Integration with AI-assisted decision-support tools within the HIS is being explored to further optimise prophylaxis management.

Author(s)

S. Ambrosini, V. Orlando, C. Provezza Provezza, A. Zaltieri, N. Zanini, N. Faroni

Why was it done?

Ensuring a multidisciplinary approach to the comprehensive care of hospitalized patients is a recognized indicator of healthcare quality. This strategy proved highly effective in the management of a patient with a multidrug-resistant Pseudomonas aeruginosa (PA) infection and a severe sacral pressure injury, requiring advanced antimicrobial therapy, targeted nutritional support, and specialized wound care to promote healing.

What was done?

Multicompromised patients increasingly challenge hospital care due to infections from multidrug-resistant (MDR) bacteria, which limit therapeutic options and complicate management. Prolonged hospitalization also raises the risk of pressure injuries, worsening metabolic stress and delaying recovery. This initiative aim to apply an integrated therapeutic strategy—combining a reserve antibiotic, advanced wound care and tailored nutritional support—to promote healing, control infection and restore nutritional balance in a highly vulnerable patient.

How was it done?

The patient received Cefiderocol (2 g every 8 hours) and Fosfomycin (4 g every 6 hours) for six weeks to treat the PA infection. The pressure injury was managed with an oxygen-enriched oleic matrix dressing from organic olive oil, allowing controlled release of reactive oxygen species (ROS) to stimulate microcirculation, cell proliferation, and antimicrobial activity. Dressings were changed two to three times weekly based on progress. Nutritional needs were supported with a high-calorie, high-protein oral supplement (ONS) containing arginine, zinc, vitamin C, selenium, and carotenoids, given once or twice daily to enhance collagen synthesis and tissue repair.

What has been achieved?

This multidisciplinary strategy enabled the prompt definition and implementation of an optimal diagnostic–therapeutic pathway. The intervention and collaboration of multiple healthcare professionals ensured a faster and more effective patient response to treatment. The active involvement of the infectious disease specialist, clinical dietitian, wound care nurse, and hospital pharmacist guaranteed comprehensive, high-quality patient management —from drug and medical device supply to the successful resolution of infection and wound healing, while preventing malnutrition.

What next?

Establishing structured treatment pathways through multidisciplinary teams contributes to a more efficient and sustainable healthcare system. This experience represents an example of best practice, highlighting how collaboration among healthcare professionals—including pharmacists as medication safety officers—can be effectively translated to other hospital settings.

Author(s)

Héctor Rodríguez-Ramallo, Nerea Báez-Gutiérrez, Alicia Melgar-Sánchez, José María Pastor-Martínez, Marta GÓNZALEZ-MARTÍNEZ, Jesus Francisco SIERRA-SÁNCHEZ.

Why was it done?

We designed and implemented a semi-automated method to estimate Days of Therapy for inpatient antibiotic use by leveraging routinely available Athos Prisma prescription exports. The workflow extracts daily prescription data and processes it with an automated script (Stata/Python/R) to generate DOT by antibiotic and hospital unit.

What was done?

DOT is a widely accepted measure of antibiotic exposure, and it is especially useful in paediatrics, where Defined Daily Doses (DDD) are unreliable due to weight variation across ages and heterogeneous “standard” dosing across centres.
Aim: to enable reliable, reproducible DOT measurement from data already available to all Athos Prisma users, facilitating stewardship dashboards and unit-level benchmarking.

How was it done?

Baseline capability: Athos Prisma supports DDD estimation but not DOT.
Data discovery: We identified a standard, centre-agnostic daily prescription export that contains the fields needed to compute DOT.
Processing pipeline: A one-click script parses the daily file, standardises drug names, groups by patient/day, and outputs DOT by antibiotic and unit.
Obstacles & solutions:
• DOT function is not integrated in Athos Prisma → built an external script that any site can run.
• Manual file export burden → consolidated to a single daily export; runtime <1 minute.
• Availability: The code is available on request and can be used by any Athos Prisma-using unit after minor local configuration.

What has been achieved?

We achieved a working code pipeline and measured DOT from June–September 2025 across the hospital. Highlights below:
Antibiotic DOTs Share of total DOT (%)
Amoxicillin/clavulanic 2608 9%
Ceftriaxone 4033 14%
Cefepime 611 2%
Piperacillin 3507 13%
Meropenem 1858 7%
Ciprofloxacin 970 3%
Levofloxacin 1495 5%
Cotrimoxazole 2443 9%
Cloxacillin 207 1%
Cefazolin 993 4%
Linezolid 751 3%
Daptomycin 678 2%

What next?

• Normalize to DOT per 100 patient-days at hospital and unit level.
• Automate the export (scheduled job) and publish weekly dashboards to stewardship teams.
• Set guardrails: prospective alerts for sustained increases in broad-spectrum DOT.
• Validate against a manual audit sample and report inter-method agreement.
• Share pack: provide a turnkey bundle to other centres.

Author(s)

S. FIRULESCU, T.F. VRABIE, M.A. MIHAI, C.D. ROTARESCU, S.R. DILIMOT, F. PETRUC, D.E. DRANCA, C. ANDREI, S. NEGRES.

Why was it done?

Infective endocarditis represents one of the most severe cardiovascular pathologies, with a mortality rate up to 30%, further complicated by rising antimicrobial resistance. The purpose of this study was to identify the most frequently encountered pathogens and to evaluate the influence of implantable cardiac devices or prosthetic heart valves. As clinical pharmacists, we also assessed treatment concordance with the European Guidelines for the management of endocarditis and hospital antibiotic policy.

What was done?

A retrospective analysis was conducted over the period January 2024-August 2025, by clinical pharmacists and residents of this specialty.

How was it done?

We evaluated patient records, focusing on the pharmacological treatment of infective endocarditis.

What has been achieved?

From a total of 104 hospitalized patients (67 males, 37 females), 66 patients were diagnosed with infective endocarditis as a primary diagnosis, while 38 patients had endocarditis as a secondary diagnosis. The patients were aged between 26 and 86 years, 60% of them being over 65 years old. Furthermore, the presence of implantable cardiac devices or valve prostheses represented a major risk factor, as it was also confirmed in this study (discovered at 55% of patients). The principal identified pathogens from blood cultures were Gram-positive cocci, such as Staphylococcus (67%) – mainly Staphylococcus aureus, both MSSA and MRSA (27%), Staphylococcus epidermidis (22%) – and Streptococcus (19%), mostly Streptococcus gallolyticus (7%). Other less common pathogens included Coxiella burnetii, Serratia marcescens, Enterococcus spp., and Stenotrophomonas maltophilia. The most commonly used antibiotics were: Vancomycin (56%), Ceftriaxone (53%), Ampicilin (42%) and Rifampicin (37%). In this study, antibiotics were used from all three AWaRe categories, as follows: 41% of patients received Access antibiotics, 41% Watch and 17% Reserve. Considering the used antibiotics and their posology, it could be estimated that in 65.4% cases, the recommendations of the current guidelines were strictly followed.

What next?

The evaluation of the guidelines concordance regarding the antimicrobial medication by clinical pharmacists as part of a multidisciplinary team is of the utmost importance for an optimized therapeutic management.

Pdf

Author(s)

Sebastian Philip, Andreas Lundgaard

Why was it done?

The screening aimed to ensure the rational use of antibiotics, contributing to the fight against antibiotic resistance and potentially shortening hospital stays by optimizing treatment.

What was done?

A systematic screening of antibiotic treatments for patients was conducted as part of the daily tasks performed by clinical pharmacists at The Medical Acute Care Unit, Bispebjerg Hospital.

How was it done?

For each patient receiving antibiotic treatment in the emergency department, the chosen therapy was systematically reviewed against regional antibiotic guidelines, considering factors such as allergies, resistance profiles, renal function, clinical indication and overall condition of the patient. Recommendations of adjustment of treatment were discussed with the attending physician for potential changes in therapy, including changes to dosage, frequency, route of administration, alternative antibiotic drug, or discontinuation of treatment. All interventions were documented, including the details of the therapy, the recommendation, and whether the attending physician approved the suggested changes.

What has been achieved?

A large dataset has been collected, detailing the number of patients receiving antibiotic treatment, the number of interventions conducted, the specific antibiotic treatment each patient received, the type of intervention performed and its indication, and whether the intervention was approved or rejected by the responsible physician.
The project has laid the groundwork for understanding the clinical pharmacist’s role in enhancing rational antibiotic pharmacotherapy.

What next?

It is planned to analyze the collected data to determine the types of changes in therapy most commonly recommended by clinical pharmacists and to which degree the interventions were approved or denied by the attending physician.
This will provide insights into the pharmaceutical contributions to more rational antibiotic use, highlighting commonly observed ‘areas for improvement’ that could potentially be addressed through education.

Author(s)

Lisa Wimmer, Beata Laszloffy, Tamara Clodi-Seitz, Doris Haider

Why was it done?

Antibiotic resistance poses a serious threat to global health, and Austria’s National Action Plan on Antibiotic Resistance (NAP-AMR) highlights the urgency of robust antibiotic stewardship, especially with the 2024 implementation of new antimicrobial quality standards. In response, a 700-bed hospital in Vienna has launched an ambitious initiative, forming a dedicated Antibiotic Stewardship (ABS) team. This interdisciplinary collaboration between physicians and clinical pharmacists is designed to revolutionize antibiotic use, curb resistance, and elevate patient care standards starting in the ICU and associated surgical units.

What was done?

The ABS team took decisive action by targeting one intensive care unit (ICU) and two surgical wards (64 beds in total) for weekly screenings. Infectious disease specialists and clinical pharmacists worked hand-in-hand, meticulously reviewing every patient’s case. This dynamic collaboration ensured not only the highest level of medication safety but also the relentless optimization of antibiotic use, pushing boundaries to meet and exceed best-practice standards.

How was it done?

The ICU and surgical wards—hotspots for antibiotic overuse—were strategically chosen for weekly reviews. In these high-risk areas, an interdisciplinary collaboration of physicians and clinical pharmacists joined forces, taking swift action to assess and fine-tune prescriptions. Pharmacists played a hands-on role, actively reviewing antibiotics and other medications, making recommendations, adjusting dosages, and halting unnecessary treatments. This collaboration was crucial in driving evidence-based decisions that directly elevated patient care to new heights.

What has been achieved?

After just four months, the project has already made significant strides, affecting a substantial number of patients. The majority of interventions have centered on refining antibiotic use, while additional recommendations on other medications have strengthened overall treatment safety. This close collaboration between physicians and pharmacists has directly improved adherence to national guidelines and sharpened prescribing practices.

What next?

Building on early successes, the ABS team will expand screening to additional departments, establishing a pivotal role for clinical pharmacists. This initiative serves as a model for other hospitals, demonstrating that significant improvements in antibiotic stewardship are possible, even with limited resources. The key takeaway: small steps can drive substantial gains in patient care and antibiotic use. As the program progresses, measurable effects on resistance patterns and antibiotic consumption are anticipated.

Pdf

Author(s)

Eva Gómez-Costa; María Begoña Feal-Cortizas; María Mateos-Salvador; Sandra Rotea-Salvo; Andrea Luaces-Rodríguez; Laura Caeiro-Martínez; Clara Fernández-Diz; Andrés Torres-Pérez; Luis Margusino-Framiñán; María Isabel Martín-Herranz

Why was it done?

Implementation of a circuit for the preparation and dispensing of elastomeric infusion pumps (EIPs) prepared in a Hospital Pharmacy Service, designed for the continuous intravenous administration of antimicrobial agents in coordination with Home Hospitalization Units (HHU).

What was done?

The purpose of this initiative is to provide an effective and safe alternative for treating infections in patients who would otherwise require prolonged hospital stays. The use of EIPs improves patients’ quality of life and reduces treatment costs by decreasing hospital admissions.

How was it done?

The Pharmacy Service contributed to the development of this initiative by studying the stability of antimicrobial agents in the EIPs, determining dilution volumes based on the maximum possible concentration, and assessing storage conditions, among other factors. The appropriate EIP was selected for each antibiotic to ensure effective and safe infusion rates. EIPs are prepared in laminar flow hoods to maintain a sterile environment during medication preparation. Additionally, educational materials for healthcare professionals were developed, and training sessions were conducted for HHU staff.

What has been achieved?

In 2023, a total of 2,223 EIPs were prepared to treat 123 patients, resulting in a reduction of 1,426 hospital days. Compared to previous years, there was a 243% increase in the number of infusers and a 131% increase in the number of patients between 2017 and 2019. Between 2019 and 2023, there was an 11.9% increase in infusers and a 36.7% increase in patients.
The antimicrobials used were: meropenem (59.6%), piperacillin/tazobactam (19.9%), cefazolin (6.8%), ceftazidime (5.6%), ceftaroline (2.2%), penicillin G (2.1%), tobramycin (1.5%), ampicillin (0.7%), acyclovir (0.6%), ceftolozane/tazobactam (0.6%), and ceftriaxone (0.4%).

What next?

Future research is expected to expand on the efficacy and safety of this methodology by studying stability times at different concentrations of agents antimicrobials to establish a sustainable model that can benefit an increasing number of patients. Additionally, patient surveys will be conducted to gather insights into their experiences and enhance their quality of life.

Author(s)

Solís-Cuñado S. (1), Sánchez-Cerviño A.C. (2), Martínez-Núñez M.E. (1), Gómez-Bermejo M. (1), Martín-Zaragoza L. (1), Rubio-Ruiz L. (1), Onteniente-González A. (1), Molina-García T. (1)
1. Hospital Pharmacy Service, Getafe University Hospital, Getafe (Madrid), Spain.
2. Hospital Pharmacy Service, Puerta de Hierro University Hospital, Majadahonda (Madrid), Spain.

Why was it done?

The implementation of multidisciplinary antimicrobial stewardship teams(AST) in hospitals optimizes antibiotic use in order to improve clinical results, reduce antibiotic toxicity and minimize the emergence and spread of multidrug resistant(MDR) bacteria.
The objective is to present targeted interventions for the improvement of the management of lower respiratory tract infections(LRTI) and to reflect the impact of these strategies through the presentation of antibiotic use results.

What was done?

Two main interventions have been implemented in LRTI:
-Protocolize the management of community-acquired pneumonia(CAP) in order to prioritize beta-lactam plus macrolide(bLM) combination versus fluoroquinolones(FQ) monotherapy. The aim is to decrease FQ consumption due to their safety issues and the major role of this antibiotics in the emergence of MDR bacteria.
-Identify patients with severe LRTI and/or risk factors of multi-drug resistant(RFMDR) bacterial infections to encourage nasal swab screening(NSS) for meticillin-resistance Staphylococcus aureus(MRSA) to promote de-escalation of anti-MRSA antibiotics.

How was it done?

Study period: 2023 and first semester of 2024.
-CAP guideline: we studied the bLM vs FQ consumption expressed as the ratio between bLM DOT/FQ DOT (Days Of Therapy; DOT) in all hospitalized patients. Analysis was carried out on forth-month period.
-NSS: we reviewed the total number of NSS performed and the impact on duration of antiMRSA antibiotics therapy. Analysis by semesters.

What has been achieved?

After protocolization, the BLM´s DOT/FQ´s DOT ratio increased 39.4% from the beginning of 2023 until 2024: 0.66 vs 0.92.
Our AST reviewed 378 episodes of LRTI. At least one nasal screening was performed in 60.6% of episodes (n=229/378) of which 29.2% were positive (n=67/229). The mean duration of treatment with anti-MRSA antibiotics in the positive cases was 7.42 days, while in the 214 negative cases it was 6.4 days.
69% of the patients with LRTI that have been reviewed in our AST meets at least one RFMDR.

What next?

The frequent lack of diagnostic value of respiratory samples, coupled with the high percentage of RFMDR patients, results in long-lasting broad-spectrum empirical antibiotic treatments.
It is therefore proposed that a polymerase chain reaction(PCR) test be performed on candidate patients for the purpose of screening for MRSA, with a view to obtaining rapid results that will facilitate earlier antibiotic de-escalations.

Author(s)

Lanzone E. (1), Baldessarelli D. (2), Tinebra A. M. (1), Albini E. M. E. (1), Panarotto A. (1), Rossi C. (1) – (1) SC Farmacia Ospedaliera ASL Novara, (2) Scuola di Specializzazione Farmacia Ospedaliera Novara.

Why was it done?

A comprehensive analysis of systemic antibiotic use in hospitals during the first half of 2024 was conducted, revealing a significant increase in the consumption of WATCH class drugs, specifically carbapenems (ATC J01DH) and fluoroquinolones (J01MA). This prompted the implementation of rigorous monitoring for prescriptions of these drug classes.

What was done?

These antibiotics are key targets of the National Plan Against Antimicrobial Resistance (PNCAR 2022-2025), which mandates a reduction of at least 10% in consumption by 2025 compared to 2022. The initiative aimed to address the rising consumption and enhance antibiotic stewardship.

How was it done?

Data were extracted from the regional IT system, with consumption expressed in Defined Daily Doses (DDD) per 100 patient days. The project monitored the use of systemic antibiotics (ATC J01), focusing on carbapenems and fluoroquinolones. Motivated requests received by the Hospital Pharmacy (FO) were reviewed for therapeutic indications, dosage, treatment duration, and the availability of an antibiogram. All requests were recorded in an Excel sheet for effective data analysis and management.

What has been achieved?

In the first half of 2024, the Hospital Pharmacy received a total of 277 motivated requests for antibiotic prescriptions. Among these, 177 requests were aligned with the objectives of the PNCAR. Specifically, there were 54 requests for fluoroquinolones, including 35 for ciprofloxacin and 19 for levofloxacin. Within this subset, 16 requests included an antibiogram, while 27 were based on empirical data. Additionally, there were 6 requests for surgical prophylaxis, 1 for continuation of therapy, 1 accompanied by a positive urine culture, and 3 that were incorrectly filled out.
The analysis of requests also highlighted a significant number related to carbapenems, with a total of 123 submissions. Of these, 120 were for meropenem, 2 for imipenem in combination with cilastatin, and 1 for ertapenem. Notably, 80 of these requests included an antibiogram, with 74 deemed appropriate based on the established criteria.

What next?

Based on the collected data, modifications to the personalized motivated request form were proposed, introducing stricter criteria for empirical use of these antibiotics. This aims to limit their use to serious and well-defined cases, representing a significant step toward more effective antibiotic therapy and improved clinical outcomes while reducing the risk of resistance. The new form specifies that ciprofloxacin and levofloxacin requests can only be made under certain conditions, and carbapenems are restricted to cases of hemodynamic instability or severe respiratory failure.

Pdf

Author(s)

Tea Stiplošek, Alenka Kovačič

Why was it done?

The growing misuse of antimicrobials, resulting in resistant microorganisms and more adverse reactions, has been identified as a significant concern. To tackle this issue, a system was put in place to systematically monitor the hospital’s dispensing and use of reserve antimicrobials.

What was done?

We established a system where each reserve antimicrobial prescription in the hospital is reviewed by a pharmacist, who decides whether to dispense the drug or suggest therapy adjustments. The dispensation of antimicrobial drug to the patient is then recorded in the patient’s medical documentation.

How was it done?

A special prescription form has been prepared, used exclusively for ordering reserve antimicrobials from the pharmacy in our hospital, separate from other medications. The form is reviewed by a pharmacist, who calculates the patient’s creatinine clearance, examines inflammatory markers, checks the alignment of treatment with the antibiogram, and reviews potential interactions with other therapies before deciding whether to dispense the drug. If necessary, the pharmacist suggests modifications to the antimicrobial treatment. Each time the antimicrobial is dispensed, it is recorded in the patient’s medical documentation for easier treatment tracking.

What has been achieved?

This approach has established systematic control over the prescription of reserve antimicrobial drugs, with a clinical pharmacist introducing an additional prescription checkpoint. Analysis of data from our work between 2020 and 2023 shows that during this period, we dispensed 16,464 courses of reserve antimicrobials, with pharmacists recommending therapy adjustments in 2,211 cases (13.6%). On average, we recommended dose reductions in 43.5% of cases due to impaired kidney function and dose increases in 23.5% due to improved kidney function or the need for appropriate dosing for specific indications. Pharmacokinetic monitoring (TDM) interventions, including those for vancomycin, amikacin, and gentamicin, accounted for 29.75% of the interventions, while 3.35% of our recommendations involved therapy changes due to inappropriate treatment based on antibiograms or the patient’s impaired kidney function.

What next?

We are digitizing the ordering system, allowing departments to request antimicrobial drugs directly through the hospital information system. We are also developing an application to calculate kidney function and verify the correct antibiotic dosage for each patient, all in one place.