232. Do Antibiotic Timeouts Improve Antibiotic Utilization?
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
  • ID Week Poster - ATO Impact - FINAL 092618.pdf (1.4 MB)
  • Background: The antibiotic timeout (ATO) is a stewardship tool that protocolizes review of objective clinical data after a pre-defined period of time and encourages antimicrobial regimen re-assessment.

    Methods: Vizient member hospitals were utilized to recruit a variety of acute healthcare institutions, including institutions with and without an ATO process. Participating institutions submitted de-identified patient-level antibiotic therapy courses from a single day within a 5-week window to create a snapshot of overall antibiotic utilization. Therapy courses were evaluated on metrics including prevalence of anti-pseudomonal agents, agents active against methicillin-resistant Staphylococcus aureus (MRSA), and oral (versus intravenous) antibiotics. The outcome measures included: percent changes in prevalence of courses with anti-pseudomonal and anti-MRSA agents after day 3, and percent change in antibiotics ordered for oral administration after day 3. These outcome measures were compared between ATO institutions and non-ATO institutions.

    Results: 6184 antibiotic therapy courses were collected from 61 participating institutions (17 ATO institutions; 44 non-ATO institutions). 10/71 institutions that completed enrollment survey did not complete submission of therapy course data. Antibiotic courses prescribed for prophylaxis (n=975) and courses that extended beyond 7 days (n=1192) were excluded from analysis, resulting in an analysis group that included 4017 therapy courses (1396 from ATO institutions vs 2621 from non-ATO institutions). The prevalence of patients receiving anti-pseudomonal agents increased after day 3 by 3.03% (p=0.28) at ATO institutions and decreased 0.45% (p=0.84) at non-ATO institutions. The prevalence of patients receiving anti-MRSA agents decreased after day 3 by 2.16% (p=0.41) at ATO institutions and decreased 5.05% (p=0.005) at non-ATO institutions. Oral antibiotic use increased after day 3 by 3.09% (p=0.08) at ATO institutions while use at non-ATO institutions increased 7.99% (p=0.0001).

    Conclusion: Antibiotic therapy course data collected across multiple sites provided no evidence for improved antimicrobial utilization among institutions that have implemented an antibiotic timeout compared to institutions without a timeout.  

    Patrick Kinn, PharmD, MPH1, Michael Postelnick, RPh BCPS AQ ID2, Kristi Kuper, PharmD, BCPS3, Amanda Gibson, PharmD4, Amy Pakyz, PharmD, MS, PhD5 and Lucas T Schulz, PharmD, BCPS (AQ-ID)1, (1)University of Wisconsin Health, Madison, WI, (2)Department of Pharmacy, Northwestern Medicine, Chicago, IL, (3)Vizient, Inc., Houston, TX, (4)University of Utah Health, Salt Lake City, UT, (5)Dept. of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, VA


    P. Kinn, None

    M. Postelnick, None

    K. Kuper, None

    A. Gibson, None

    A. Pakyz, None

    L. T. Schulz, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.