{
  "abstract": "Background and Importance Antimicrobial resistance is a major global health threat in the world. Hospital pharmacists play a key role in antimicrobial stewardship programs (ASP), promoting the rational use of antimicrobials and improving clinical outcomes. Evaluating the acceptance of pharmacist-led interventions is essential to assess their clinical impact and identify opportunities for improvement within multidisciplinary teams.Aim and Objectives To analyse and evaluate the acceptance rate of interventions performed by hospital pharmacists within the Antimicrobial Stewardship Program (ASP) during February 2025.Material and Methods A retrospective descriptive study was conducted in a tertiary hospital to assess pharmacist interventions within the ASP team and their acceptance by clinicians. Patients prescribed restricted broad-spectrum antimicrobials (carbapenems, aztreonam, tigecycline, daptomycin, last-generation cephalosporins, linezolid and echinocandins) were included. Two pharmacists reviewed prescriptions daily using the electronic prescribing system, collecting microbiological, analytical and clinical data. Cases were discussed in daily meetings with the infectious disease specialist, based on the hospital’s antimicrobial guidelines and current literature. Collected variables included demographics (age, sex), type of therapy (empirical, targeted or prophylactic), concomitant antibiotics, type of infection, intervention and acceptance.Results 97 patients were included (61.9% male; mean age 71.8 years). A total of 146 restricted antimicrobials were reviewed, mainly meropenem (39.7%), ertapenem (21.2%) and linezolid (6.2%). Most treatments were empirical (52.4%) or targeted (42.7%). Concomitant non-restricted antibiotics were used in 32 patients, mainly piperacillin/tazobactam (15.6%), trimethoprim/sulfamethoxazole (12.5%) and vancomycin (12.5%). The most frequent infections were urinary and respiratory (15.5% each), followed by intra-abdominal, bacteraemia (14.7%), skin and soft tissue infections (11.6%) and sepsis (10.9%). Overall, 41.9% of prescriptions were inappropriate, leading to 69 pharmacist interventions, of which 56.5% were accepted. The most frequent interventions were de-escalation (40%), dose adjustment (24.2%), optimisation of duration (14.5%) and discontinuation of unnecessary antimicrobials (8.1%). The highest acceptance rates were seen for de-escalation (68%), duration optimisation (66.7%) and discontinuation of unnecessary antibiotics (60%).Conclusion and Relevance This study highlights the key role of hospital pharmacists in the ASP team, with over half of pharmacist interventions accepted by clinicians. High acceptance of de-escalation, treatment duration optimisation and antimicrobial discontinuation underscores the pharmacist’s contribution to clinical decision making and supports continued reinforcement of stewardship activities to ensure rational antimicrobial use.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital Universitario Virgen Macarena, Hospital Pharmacy, Seville, Spain"
      ],
      "name": "BDM Rodríguez Sánchez-Laulhé"
    },
    {
      "affiliations": [
        "Hospital Universitario Virgen Macarena, Hospital Pharmacy, Seville, Spain"
      ],
      "name": "M Beltrán García"
    },
    {
      "affiliations": [
        "Hospital Universitario Reina Sofía, Hospital Pharmacy, Murcia, Spain"
      ],
      "name": "P Fernández-Villacañas Fernández"
    },
    {
      "affiliations": [
        "Hospital Universitario Virgen Macarena, Hospital Pharmacy, Seville, Spain"
      ],
      "name": "C Moya Mangas"
    }
  ],
  "title": "4CPS-239 Role of the hospital pharmacist in optimising antimicrobial use within the antimicrobial stewardship program",
  "uid": "1f1eb2f2-e271-5096-a706-d3117b573b7e"
}