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Introduction Although bacterial co- and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19. Methods In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of an antibiotic prescription in patients with a confirmed COVID-19 diagnosis. Results Of 403 eligible participants with a suspected COVID-19 infection, 281 were included. In 13.8% of the 203 admissions with a COVID-19 confirmed diagnosis, antibiotics were initiated for a (presumed) bacterial respiratory tract co-/superinfection (0.86 DDD/admission; 8.92 DDD/100 bed days; 39.4% were scored as ‘appropriate’). Five drivers of antibiotic prescribing were identified: history of cerebrovascular disease, high neutrophil/lymphocyte ratio in male patients, age, elevated ferritin levels and the collection of respiratory samples for bacteriological analysis. Conclusion In the studied population, the antibiotic consumption for a (presumed) bacterial respiratory tract co-/superinfection was low. In particular, the small total number of DDDs in patients with confirmed COVID-19 diagnosis suggests thoughtful antibiotic use. However, antibiotic stewardship programmes remain crucial to counter unnecessary and inappropriate antibiotic use in hospitalized patients with COVID-19. Trial Registration The study is registered at ClinicalTrials.gov (NCT04544072). Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00535-2.

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This study aims to quantify antibiotic consumption for suspected respiratory tract superinfections in COVID-19 patients, while investigating the associated drivers of antibiotic prescribing in light of the current signs of antibiotic overuse. Adult patients with a positive COVID-19 diagnosis admitted to a Belgian 721-bed university hospital were analyzed retrospectively (March 11th–May 4th, 2020), excluding short-term admissions (

Background and importance Registration of clinical activities and interventions is essential for an objective evaluation of the pharmacist’s contribution to pharmacotherapy. However, in Belgium, a nationally standardised classification system is lacking, prohibiting structured and uniform registration of drug related problems (DRPs) and pharmaceutical interventions (PIs), thus complicating benchmarking and feedback to management and government. Aim and objectives To develop and validate a Belgian classification system for clinical pharmacy activities, based on the literature and stakeholders’ opinions. Material and methods Firstly, existing classification systems for DRPs and PIs were identified through a systematic literature review. Secondly, through a nationwide electronic survey (Snap Surveys; June–July 2018) we assessed current registration practices of Belgian hospital pharmacists and their opinions regarding an ideal registration system. This information was used to develop a preliminary version of the classification system, which was further evaluated by major stakeholders (hospitals, universities, government) during a focus group discussion (September 2018). A final version was validated and assessed for interrater reliability in a second nationwide electronic non-Delphi survey (March–April 2019), comprising the classification of DRPs and PIs in 45 theoretical cases. Participants were also asked to score interpretability, user friendliness and user satisfaction. Results Following the literature review, 22 classification systems were identified, all with different categories and numbers of categories. Both the survey and focus group discussion revealed that the use of validated systems is very scant, but desirable in Belgium, with practicality and time investment as the most important characteristics. The final classification system included seven clinical activities, grouped into four activity classes. The most extensive activity class (ie, medication review) included 29 DRPs and 22 PIs. Forty-four hospital pharmacists participated in the validation study. Interrater reliability was substantial for the DRPs (Fleiss’ κ=0.731) and PIs (Fleiss’ κ=0.784). The classification system was found to be user friendly, with good interpretability and user satisfaction, resulting in a very high interest to use our system in daily practice. Conclusion and relevance A classification system, adapted to Belgian clinical pharmacy activities, was developed and validated, and was well received by hospital pharmacists. The final version will be promoted at different levels for use in daily practice. References and/or acknowledgements No conflict of interest.

Background Opioids easily cause adverse drug events (ADEs) or therapeutic failure in cases of prescribing errors, resulting in increased costs for the hospital, patient and healthcare system. The clinical pharmacist can detect and resolve these errors by performing prescription order validation (POV). Little data is available on the economic impact of this service. Purpose To evaluate the cost-outcome of pharmacist-initiated interventions on opioid prescriptions during POV, in terms of cost savings and cost avoidance (CA) for the institution. Material and methods Pharmacist interventions in prescriptions of fentanyl, hydromorphone, methadone, morphine, oxycodone and piritramide in a Belgian tertiary university hospital of 721 beds, UZ Brussel, were analysed (period 1 February 2017–31 January 2018). The potential drug cost without intervention was compared to the cost with intervention. An expert panel assessed the probability of ADE occurrence by assigning a probability estimate (PE) to every patient (0–no effect; 0.01–very low; 0.1–low; 0.4–medium; 0.6–high). The ADE-CA was calculated by multiplying the hospital’s cost of an ADE (calculated according to a method proposed by the Belgian Healthcare Knowledge Centre) by the PE. The total benefit was calculated as the sum of the drug cost difference and the ADE-CA. Personnel costs were estimated and subtracted from the estimated benefit to assess the final cost-benefit. A sensitivity analysis was added to determine the impact of assumptions on PEs, CA and employer’s expenses. Results In 3040 prescriptions, 94 interventions were registered. Posology-related DRPs were the most common (59%). Sixty-two per cent of the errors were assigned a PE of medium (30%) or high (32%) level. Total drug cost savings amounted to €395.30 (median €1.47/intervention, range -€21.01 to €67.23). After adding ADE-CA, we found a total benefit of €8,559.92 (cost-benefit ratio: 2.32). Mostly variations in the ADE-CA affected the outcome. A lower and upper limit of respectively -€1,386.56 and €27,307.49 were calculated. Conclusion This is the first Belgian study to evaluate the POV of opioids as a profitable service for the hospital. Because of some limitations in the method, further refinements are required for more accurate results. These findings demonstrate that hospital management should also take into account the potential savings induced by clinical pharmacists and cannot only rely on limited government funding. References and/or acknowledgements None. No conflict of interest.