Impact of the day of the week on the discontinuation of broad-spectrum antibiotic prescriptions; a multi-centered observational study

Abstract

To encourage and guide antimicrobial stewardship team (AST) activity and promote appropriate antibiotic use, we studied the impact of day of the week on the initiation and discontinuation of antibiotic administration. This was a multicenter observational study conducted at 8 Japanese hospitals from April 1 to September 30, 2019, targeting patients who underwent treatment with broad-spectrum antibiotics, such as anti-methicillin-resistant Staphylococcus aureus agents and anti-pseudomonal agents. We compared the weekly numbers of initiations and discontinuations of antibiotic prescription on each day of the week or on the days after a holiday. There was no statistical difference in the number of antibiotic initiations on both weekdays and the day after a holiday. However, antibiotic discontinuation was significantly higher from Tuesday onward than Monday and from the second day than the first day after a holiday. Similar trends were observed regardless of the categories of antibiotics, hospital and admission ward, and AST activity. This study suggests that broad-spectrum antibiotics tend to be continued during weekends and holidays and are most likely to be discontinued on Tuesday or the second day after a holiday. This was probably due to behavioral factors beyond medical indications, requiring further antimicrobial stewardship efforts in the future.

Measuring empiric antibiotic spectrum—A journey through space and time

“…4,13 Two prior studies evaluated the effect of weekdays on broad-spectrum antibiotic discontinuation in inpatient settings. 5,14 Similar to our data, one of these studies also identified increased rates of broad-spectrum initiations on weekends. Our study encompassed a larger number of admissions and was the first, to our knowledge, to utilize an antibiotic spectrum index to provide more granular detail on breadth of empiric antibiotic prescribing across time of day and hospital unit.…”

“…[1][2][3] Some prior studies have also suggested a "weekend effect" in antimicrobial prescribing patterns, where less 'appropriate' antimicrobials are prescribed on weekends or broad antimicrobials are disproportionately discontinued on certain days of the week. 4,5 Analytic tools that evaluate both antibiotic use and antibiotic spectrum by hospital location and time of day could better identify where and when antibiotic decisions that involve broad-spectrum antibiotics occur. With this knowledge, antimicrobial stewardship programs (ASPs) might better investigate and develop interventions to support decision makers during times of broader antibiotic use and identify gaps in resources across space and time.…”

Antimicrobials in the Hospital Are Unevenly Discontinued on Weekdays

“…The present study revealed disproportionate discontinuation of all intravenous antimicrobials during weekdays at our hospital. Our previous studies showed that the administration of broad-spectrum antimicrobials was discontinued on Tuesday or day 2 after holidays ( 7 , 8 ). As has been discussed in previous reports, infectious diseases occur on all days of the week; therefore, the initiation and discontinuation of their treatment should not be biased toward any particular day.…”

“…This was a single-facility retrospective observational study conducted at the Okayama University Hospital, Japan, referring to our previous studies ( 7 , 8 ). The study period was between January 1, 2018, and December 31, 2020 (3 years), during which we collected administrative data on the in-hospital use of all the intravenous antimicrobials (both antibiotics and antifungals).…”

“…However, social and environmental factors, such as staffing shortages and limited medical resources, are known to influence prescribing antibiotics beyond the medical indication ( 5 , 6 ). Our previous studies have also demonstrated the intra-week disproportion of antibiotic termination; however, those studies included only patients receiving broad-spectrum antimicrobials ( 7 , 8 ). To clarify the generalizability for this prescription tendency, we performed another study that comprehensively covered all antimicrobial agents in a hospital, regardless of their spectrum.…”