Do Antibiotic Timeouts Improve Antibiotic Utilization?

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.