Balancing the Efficacy and Safety of Implementing a Piperacillin/tazobactam (PTZ) Antibiotic Time-out

Abstract

BackgroundWith the rise of antimicrobial resistance, the Centers for Disease Control and Joint Commission have promulgated a national initiative for antimicrobial stewardship programs (ASP). ASP use a multimodal approach such as antibiotic time outs to limit the duration of empiric therapy. Yale New Haven Hospital implemented the use of a 72-hour stop in the electronic medical system (EMR) for empiric PTZ orders. To mitigate the risk of orders inadvertently falling off, a dynamic scoring system was created in the EMR to alert pharmacists of expiring orders in real time. The primary objective of this study was to evaluate the duration of empiric PTZ prior to and after the implementation of the antibiotic time-out. Secondary outcomes included de-escalation, appropriateness of dosing, and safety.MethodsA retrospective cohort study using the EMR was conducted. Cases were defined as adult inpatients who had empiric orders for PTZ without positive cultures. The control group consisted of patients from September to October of 2014, prior to the 72-hour stop. The intervention group included patients from September to October of 2016. Due to the nationwide shortage of PTZ in 2015, this year was excluded in addition to patients with culture documented infections, stem cell/solid organ transplants or febrile neutropenia. Data collected included baseline demographics, renal function, PTZ dose, frequency and duration, indication and final antibiotic selection.ResultsOf the 537 random patients reviewed, 300 met inclusion criteria; 150 patients in the control group and 150 patients in the intervention group. The average duration of PTZ decreased from 4 days in the control group to 3 days in the intervention group (P = 0.0013). Overall antibiotic use decreased from 6 days in the control group to 5 days in the intervention group (P = <0.0001). There was an increase in the correct dose and frequency from 35% to 60% of orders in the intervention group compared with the control group (P = 0.004). With the aid of the scoring system, there were no orders that fell off inappropriately in the intervention group.ConclusionFollowing the successful implementation of a 72-hour antibiotic timeout we saw a significant decrease in the duration of empiric use, inappropriate dosing and an increase in the rate of antibiotic de-escalation.Disclosures All authors: No reported disclosures.