Impact of a Prescriber-driven Antibiotic Time-out on Antibiotic Use in Hospitalized Patients

Thom, Kerri A.; Harris, Anthony D.; Dzintars, Kathryn; Morgan, Daniel J.; Li, Shanshan; Pineles, Lisa; Srinivasan, Arjun; Avdic, Edina; Cosgrove, Sara E.

doi:10.1093/cid/ciy852

Cited by 32 publications

(41 citation statements)

References 8 publications

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“…13 Interestingly, an ATO using a paper checklist on hospital days 3-5 showed no impact on antibiotic use. 5 Scheduling and personnel issues may have impacted our study. The ATOs were not performed on weekends or holidays, reducing opportunities by~30%.…”

Section: Discussionmentioning

confidence: 99%

“…ATO using a paper form filled out on hospital days 3-5 decreased "inappropriate" antibiotic prescribing from 45% to 31% but did not change any other antibiotic use measure. 5 Two studies utilized electronic notifications to prompt ATOs. Graber et al required users to enter a structured clinical note if vancomycin or piperacillin-tazobactam were continued for >3 days.…”

Section: Discussionmentioning

confidence: 99%

“…Although ATOs make inherent sense, data showing their efficacy regarding changing antimicrobial use or improving care are limited. [4][5][6] Many questions exist regarding how to effectively implement ATOs, who should initiate an ATO, and whether ATOs improve antimicrobial use. To evaluate these questions, we performed a cluster-randomized trial of ATOs on inpatient medical teams using team-based pharmacists to prompt antimicrobial review.…”

mentioning

confidence: 99%

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Cluster randomized trial of an antibiotic time-out led by a team-based pharmacist

Schooneveld

Rupp

Cavaleiri

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: Antibiotic time-outs (ATOs) have been advocated to improve antibiotic use without dedicated stewardship resources, but their utility is poorly defined. We sought to evaluate the effectiveness of an ATO led by a team-based pharmacist. Design: Cluster randomized controlled trial. Setting: Six medicine teams at an academic medical facility. Patients: Inpatients who received antibiotics and were cared for by a medicine team. Intervention: In phase A (2 months) pharmacist-led ATOs were implemented on 3 medicine teams (ATO-A) while 3 teams maintained usual care (UC-A). In phase B (2 months), ATOs were continued in the ATO group (ATO-B) and ATOs were initiated in the UC group (UC ATO-B). We targeted 2 ATO points: early (<72 hours after antibiotics were initiated) and late (after the early period but ≤5 days after antibiotic initiation). Results: In total, 290 ATOs were documented (181 early, 87 late, and 22 subsequent) among 538 admissions. The most common ATO recommendations were narrow therapy (148 of 290), no change (124 of 290), and change to oral (30 of 290). ATO initiation was lower in the UC ATO-B group than in either ATO group (21.8% UC ATO-B vs 69.2% ATO-A and -B). Overall antibiotic use was not different between the groups (P = .51), although intravenous (IV) levofloxacin use decreased in the UC group after ATO implementation (49 DOT/1,000 PD vs 20 DOT/1,000 PD; P = .022). The ratio of oral (PO) to intravenous (IV) DOT was lower in the UC group than in any of the ATO groups (P = .032). We detected no differences in mortality, length of stay, readmission, C. difficile infection, or antibiotic adverse events. Conclusions: Implementation of a pharmacist-led ATO was feasible and well accepted but did not change overall antibiotic use. An ATO may promote increased use of oral antibiotics, but more effective strategies for self-stewardship are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Cluster randomized trial of an antibiotic time-out led by a team-based pharmacist

Schooneveld

Rupp

Cavaleiri

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…12,27 Effects of ATO interventions in hospitals have been mixed. [18][19][20][21][22][23] Senn et al 18 showed that prompting inpatient teams to provide a justification for continuing intravenous antibiotic therapy after 72 hours of use led to modest increases in the frequency of modifications of existing intravenous antibiotic therapy and a 14% overall reduction in total days of antibiotic therapy. 18 In contrast, Thom et al 22 showed that an ATO intervention had no effect on overall antibiotic utilization.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 Studies performed in hospitals have shown that ATO interventions can increase the frequency of discontinuing unnecessary antibiotics and de-escalation of broad-spectrum antibiotics. [18][19][20][21][22][23] However, these interventions do not appear to be as effective as other stewardship approaches such as prior authorization and prospective audit and feedback. 19,22,23 ATO interventions are lower in cost than prior authorization and prospective audit and feedback, and they may be particularly well suited to low-resource health settings like nursing homes.…”

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confidence: 99%

Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes

Liao

Nace

Crnich

et al. 2020

Infect. Control Hosp. Epidemiol.

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Background:Antibiotic overuse and misuse is a common problem in nursing homes. Antibiotic time-out (ATO) interventions have led to improvements in antibiotic uses in hospitals, but their impact in nursing homes remain understudied.Objective:To evaluate the impact of a stewardship intervention, promoting use of ATOs on the frequency and types of antibiotic change events (ACEs) in nursing homes.Design:Controlled before-and-after intervention study.Setting:Nursing homes in Wisconsin and Pennsylvania.Method:Data on antibiotic prescriptions in 11 nursing homes were collected for 25 months. We categorized ACEs as (1) early discontinuation, (2) class modification, or (3) administration modification. Class modification ACEs were further classified based on whether the change narrowed, expanded, or had no effect on bacterial spectrum coverage. Analyses were performed using a difference-in-difference (DiD) approach.Result:Of 2,647 antibiotic events initiated in study nursing homes, 376 (14.2%) were associated with an ACE. The overall proportion of ACEs did not significantly differ between intervention and control nursing homes. Early discontinuation ACEs increased in intervention nursing homes (DiD, 2.5%; P = .01), primarily affecting residents initiated on broad-spectrum antibiotics (DiD, 2.9%; P < .01). Class modification ACEs decreased in intervention nursing homes but remained unchanged in control nursing homes.Conclusion:The impact of an ATO intervention in study nursing homes was mixed with increases in early discontinuation ACEs offset by reductions in class modification ACEs. More research on the potential value of ATO interventions in nursing homes is warranted.

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Antibiotic modification versus withhold in febrile patients without evidence of bacterial infection, unresponsive to initial empiric regimen: a multicentre retrospective study conducted in Israel

Mudrik-Zohar

Nissan

Stein

et al. 2020

Eur J Clin Microbiol Infect Dis

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Impact of a Prescriber-driven Antibiotic Time-out on Antibiotic Use in Hospitalized Patients

Cited by 32 publications

References 8 publications

Cluster randomized trial of an antibiotic time-out led by a team-based pharmacist

Cluster randomized trial of an antibiotic time-out led by a team-based pharmacist

Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes

Antibiotic modification versus withhold in febrile patients without evidence of bacterial infection, unresponsive to initial empiric regimen: a multicentre retrospective study conducted in Israel

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