Methods: A quasi-experimental study to evaluate the impact of an ATO on decreasing abx use was performed over a 6-mo base period and 9-mo intervention period in 11 units across 6 hospitals in the greater Maryland region was conducted. Patients who received abx for at least 3 calendar days were eligible for study inclusion. Outcomes included days of abx therapy (DOT) per admission to cohort as well as percent of patients with a change in abx regimen on day 3-5 and appropriateness of abx regimens on days 3-5. Appropriateness of abx therapy was adjudicated by infectious diseases (ID) clinicians using prespecified criteria. Regression analysis was used to compare outcomes between the base and intervention periods.
Results: 3448 abx courses were reviewed, including 1541 during the base and 1907 during the intervention period. Overall DOT per cohort admission was similar between the two periods (12.7 vs.12.2 hospital DOT per admission in the base and intervention periods, respectively and was not statistically significant after controlling for unit and season (P = 0.18). After adjusting for season, unit, ID consultation, and comorbidities, there was a 36% increase in the odds of changing or discontinuing abx on days 3-5 in the intervention period compared to the base period (48% vs. 54%, p < 0.05). Similarly, there was an 89% increase in the odds of receiving an appropriate abx regimen on days 3-5 in the intervention period compared to the base period (53% vs. 68%, P < 0.01). There was no difference in rate of Clostridium difficile lab-events in the two study periods.
In this multicenter study, we found that performance of an ATO by frontline providers was effective at improving the appropriateness of abx therapy 3-5 days after initiation, but did not change the amount of abx use, suggesting that additional interventions, perhaps later during hospitalization or at discharge, are needed to impact duration of abx therapy.
A. D. Harris, None
D. Morgan, None
K. Dzintars, None
A. Srinivasan, None
E. Avdic, None
D. X. Li, None
L. Pineles, None
S. E. Cosgrove, None
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