Meeting NewsPerspective

Antibiotic ‘timeouts’ improve appropriateness of therapy, not number of prescriptions

SAN DIEGO — A quasi-experimental study conducted in numerous hospitals in Maryland showed that antibiotic timeouts did not change the amount of antibiotics prescribed to patients after 3 to 5 days of therapy, but the intervention did improve the appropriateness of the prescriptions.

Among its seven core elements of hospital antimicrobial stewardship, the CDC recommends that hospitals implement at least one action, including antibiotic timeouts, to curb unnecessary antibiotic use. Antibiotic timeouts allow physicians to re-evaluate a patient’s ongoing treatment after a few days to determine whether the therapy is working and if a change in prescription is needed.

“Our goal in this study was to evaluate whether an antibiotic timeout by frontline clinicians after 3 to 5 days of antibiotic therapy would lead to a reduction in unnecessary antibiotic use,” Kerri A. Thom, MD, MS, an associate professor of epidemiology and public health at the University of Maryland School of Medicine, said during a presentation here.

In the study, six hospitals in the state used antibiotic timeouts during a 9-month intervention period. In several cases, the hospitals did not have an antimicrobial stewardship program in place, or one had just been newly established.

The primary endpoint was the number days of antibiotic therapy, and the researchers also calculated the percentage of patients during the intervention who changed their antibiotic regimen after 3 to 5 days. During each timeout, providers completed a paper form to review the type of antibiotics that were initially prescribed to patients and their indications, provide a clinical assessment, and to plan for a change in therapy if necessary. Up to two infectious disease clinicians adjudicated the appropriateness of the therapy. A total of 3,470 antibiotic courses were prescribed during the study — 2,968 for adults and 502 for children.

According to the researchers, the overall number of days of antibiotic therapy during a 6-month baseline period and the intervention period was similar — 12.7 vs. 12.2 hospital days of therapy per admission, respectively. However, after adjusting for factors like the type of hospital unit and season, the researchers found that during the intervention period, there was an approximately 36% increase in the odds of patients changing or discontinuing their antibiotic regimen after 3 to 5 days (48% vs. 54%; P < .05) — a modest but statistically significant change, Thom noted. Additionally, there was a 78% increase in the odds of receiving an appropriate antibiotic regimen after 3 to 5 days of therapy in the intervention period compared with the baseline period (55% vs. 69%; P < .01).

Thom and colleagues found no difference in the rate of Clostridium difficile infections between the baseline and intervention periods.

The finding that antibiotic timeouts were effective at improving the appropriateness of the prescriptions but not the overall quantity of antibiotics suggests that additional interventions are needed to impact the duration of therapy.

“How does this translate to your hospital?” Thom asked. “In my opinion, provider-driven timeouts may be a useful adjunct but not a replacement for a formal stewardship team.” – by John Schoen

References:

CDC. Core Elements of Hospital Antibiotic Stewardship Programs. https://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html. Accessed October 5, 2017.

Thom K, et al. Abstract 894. Presented at: IDWeek; Oct. 4-8, 2017; San Diego.

Disclosure: The authors report no relevant financial disclosures.

SAN DIEGO — A quasi-experimental study conducted in numerous hospitals in Maryland showed that antibiotic timeouts did not change the amount of antibiotics prescribed to patients after 3 to 5 days of therapy, but the intervention did improve the appropriateness of the prescriptions.

Among its seven core elements of hospital antimicrobial stewardship, the CDC recommends that hospitals implement at least one action, including antibiotic timeouts, to curb unnecessary antibiotic use. Antibiotic timeouts allow physicians to re-evaluate a patient’s ongoing treatment after a few days to determine whether the therapy is working and if a change in prescription is needed.

“Our goal in this study was to evaluate whether an antibiotic timeout by frontline clinicians after 3 to 5 days of antibiotic therapy would lead to a reduction in unnecessary antibiotic use,” Kerri A. Thom, MD, MS, an associate professor of epidemiology and public health at the University of Maryland School of Medicine, said during a presentation here.

In the study, six hospitals in the state used antibiotic timeouts during a 9-month intervention period. In several cases, the hospitals did not have an antimicrobial stewardship program in place, or one had just been newly established.

The primary endpoint was the number days of antibiotic therapy, and the researchers also calculated the percentage of patients during the intervention who changed their antibiotic regimen after 3 to 5 days. During each timeout, providers completed a paper form to review the type of antibiotics that were initially prescribed to patients and their indications, provide a clinical assessment, and to plan for a change in therapy if necessary. Up to two infectious disease clinicians adjudicated the appropriateness of the therapy. A total of 3,470 antibiotic courses were prescribed during the study — 2,968 for adults and 502 for children.

According to the researchers, the overall number of days of antibiotic therapy during a 6-month baseline period and the intervention period was similar — 12.7 vs. 12.2 hospital days of therapy per admission, respectively. However, after adjusting for factors like the type of hospital unit and season, the researchers found that during the intervention period, there was an approximately 36% increase in the odds of patients changing or discontinuing their antibiotic regimen after 3 to 5 days (48% vs. 54%; P < .05) — a modest but statistically significant change, Thom noted. Additionally, there was a 78% increase in the odds of receiving an appropriate antibiotic regimen after 3 to 5 days of therapy in the intervention period compared with the baseline period (55% vs. 69%; P < .01).

Thom and colleagues found no difference in the rate of Clostridium difficile infections between the baseline and intervention periods.

The finding that antibiotic timeouts were effective at improving the appropriateness of the prescriptions but not the overall quantity of antibiotics suggests that additional interventions are needed to impact the duration of therapy.

“How does this translate to your hospital?” Thom asked. “In my opinion, provider-driven timeouts may be a useful adjunct but not a replacement for a formal stewardship team.” – by John Schoen

References:

CDC. Core Elements of Hospital Antibiotic Stewardship Programs. https://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html. Accessed October 5, 2017.

Thom K, et al. Abstract 894. Presented at: IDWeek; Oct. 4-8, 2017; San Diego.

Disclosure: The authors report no relevant financial disclosures.

    Perspective
    Susan C. Bleasdale

    Susan C. Bleasdale

    Antimicrobial stewardship is the right diagnosis, the right drug and the right duration. This study is getting at the right drug. It is not an intervention affecting empiric antibiotic use. The point of the antibiotic timeout was to say, “Hey, stop and re-evaluate the data that you have,” and that led to changes to more appropriate antibiotic use. The intervention would not necessarily affect the overall use of antibiotics. I think this is an important component of antimicrobial stewardship.

    • Susan C. Bleasdale, MD
    • Medical director, infection prevention and control University of Illinois Hospital and Health Sciences System

    Disclosures: Bleasdale reports no relevant financial disclosures.

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