Clinical Impact of an Antibiotic Time Out Initiative at an Academic Medical Center

Abstract

Background: Various strategies aimed at limiting inappropriate antimicrobial use including antibiotic time out (ATO) have been proposed to combat the development of antimicrobial resistance, yet there are limited studies that have assessed the impact of ATO on clinical outcomes. Methods: This single-center retrospective study reviewed the effect of a passive ATO strategy by comparing 100 adult patients with an ATO matched by infection type to 100 antibiotic-treated adult patients lacking an ATO note. Results: No difference in clinical outcomes was observed, however, ATO did result in improved optimization of antibiotic selection and duration, and reduction of piperacillin/tazobactam and vancomycin use. Conclusion: Further studies are warranted to evaluate the impact of ATO on clinical outcomes of a larger homogenous population with specified infectious diagnoses and clinical characteristics.

Keywords

anti-infectives infectious diseases outcomes research

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References

Barlam

Cosgrove

Abbo

, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-e77.

Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: Centers for Disease Control and Prevention; 23 February 2017. https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.html. Accessed 22 October 2018.

The Joint Commission. New Antimicrobial Stewardship Standard. Oakbrook Terrace, IL: The Joint Commission; July 2017. https://www.jointcommission.org/assets/1/6/New_Antimicrobial_Stewardship_Standard.pdf. Accessed 22 October 2018.

Lee

Frenette

Jayaraman

Green

Pilote

Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial use. Ann Intern Med. 2014;161(10):53-58.

Thom

Tamma

Harris

, et al. Impact of a prescriber-driven antibiotic time-out on antibiotic use. Clin Infect Dis. 2019;68(9):1581-1584.

Graber

Jones

Glassman

, et al. Taking an antibiotic time-out: utilization and usability of a self-stewardship time-out program for renewal of vancomycin and piperacillin-tazobactam. Hosp Pharm. 2015;50(11):1011-1024.

Jones

Graber

Butler

, et al. Decreased vancomycin use after implementation of a decision support program for antibiotic time outs. Open Forum Infect Dis. 2014;1(1):S54.

Vasina

Dehner

Wong

, et al. The impact of a pharmacist driven 48-hour antibiotic time out during multi-disciplinary rounds on antibiotic utilization in a community non-teaching hospital. Open Forum Infect Dis. 2017;4(1):S272-S273.

Vakil

Hirai-Yang

Gaut

, et al. Antimicrobial time out: novel approach to expand antimicrobial stewardship in a large, tertiary medical center. Open Forum Infect Dis. 2015;2(1):1417.

10.

Van Schnooneveld

Rupp

Lyden

Cavalieri

Marolf

Rolek

Randomized trial of team pharmacist-led antimicrobial time out. Open Forum Infect Dis. 2016;3(1):1942.

11.

Kellum

Lameire

Aspelin

, et al. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1-141.

12.

Jammal

Mcmanus

Tirmizi

Topal

Balancing the efficacy and safety of implementing a piperacillin/tazobactam (PTZ) antibiotic time-out. Open Forum Infect Dis. 2017;4(suppl 1):S488.