Abstract
To minimize complications associated with over-utilization of antibiotics, many antimicrobial stewardship programs have incorporated an antibiotic time out (ATO); however, limited data are available to support its effectiveness. This was a single-center retrospective cohort study assessing the impact of the automated electronic ATO in the setting of Gram-negative bacteremia. The primary outcome was the proportion of patients who received a modification of therapy within 24 h of final culture results. Secondary outcomes included modification at any point in therapy, time to modification of therapy, time to de-escalation, and days of therapy of broad-spectrum antibiotics. There was a total of 222 patients who met inclusion criteria, 97 patients pre-ATO and 125 patients post-ATO. The primary outcome of modification of therapy within 24 h of final culture results was not significantly different (24% vs. 30%, p = 0.33). The secondary outcome of modification of therapy at any point in therapy was not significantly different between the two groups (65% vs. 67%, p = 0.73). All other secondary outcomes were not significantly different. The ATO alert was not associated with a higher rate of antibiotic modification within 24 h of culture results in patients with GNB. Further efforts are needed to optimize the ATO strategy and antibiotic prescribing practices.
Highlights
While broad-spectrum antibiotics may be effective to treat a variety of infections, their over-utilization may lead to superinfections and contribute to the development of antimicrobial resistance
An antibiotic time out (ATO) is a strategy endorsed by the Centers for Disease Control and Prevention (CDC) and the Joint Commission (TJC), which encourages a re-evaluation of antibiotic therapy at a pre-specified time point during empiric treatment after clinical results have been reported [1,2]
Previous studies [3,4,5] have assessed the efficacy of an ATO strategy involving prospective audit and feedback (PAF) in which an infectious diseases (ID) physician or pharmacist reviews individual patient cases and intervenes when a change in therapy is deemed appropriate
Summary
While broad-spectrum antibiotics may be effective to treat a variety of infections, their over-utilization may lead to superinfections and contribute to the development of antimicrobial resistance. Stewardship programs include a variety of effective strategies to optimize antimicrobial therapy, including an antibiotic time out (ATO). Previous studies [3,4,5] have assessed the efficacy of an ATO strategy involving prospective audit and feedback (PAF) in which an infectious diseases (ID) physician or pharmacist reviews individual patient cases and intervenes when a change in therapy is deemed appropriate. These studies suggested that this type of intervention may be effective as an adjunct
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