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
Posters
  • 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

    Disclosures:

    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.