Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-13T00:38:12.977Z Has data issue: false hasContentIssue false
  • English
  • Français

Cluster randomized trial of an antibiotic time-out led by a team-based pharmacist

Published online by Cambridge University Press:  20 August 2020

Trevor C. Van Schooneveld Open the ORCID record for Trevor C. Van Schooneveld [Opens in a new window] ,
Mark E. Rupp ,
R. Jenifer Cavaleiri ,
Elizabeth Lyden  and
Kiri Rolek
Trevor C. Van Schooneveld*
Affiliation:
Division of Infectious Disease, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Mark E. Rupp
Affiliation:
Division of Infectious Disease, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
R. Jenifer Cavaleiri
Affiliation:
Division of Infectious Disease, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Elizabeth Lyden
Affiliation:
College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
Kiri Rolek
Affiliation:
College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska Department of Pharmacy, Nebraska Medicine, Omaha, Nebraska
*
Author for correspondence: Trevor C. Van Schooneveld, E-mail: tvanscho@unmc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Antibiotic time-outs (ATOs) have been advocated to improve antibiotic use without dedicated stewardship resources, but their utility is poorly defined. We sought to evaluate the effectiveness of an ATO led by a team-based pharmacist.

Design:

Cluster randomized controlled trial.

Setting:

Six medicine teams at an academic medical facility.

Patients:

Inpatients who received antibiotics and were cared for by a medicine team.

Intervention:

In phase A (2 months) pharmacist-led ATOs were implemented on 3 medicine teams (ATO-A) while 3 teams maintained usual care (UC-A). In phase B (2 months), ATOs were continued in the ATO group (ATO-B) and ATOs were initiated in the UC group (UC ATO-B). We targeted 2 ATO points: early (<72 hours after antibiotics were initiated) and late (after the early period but ≤5 days after antibiotic initiation).

Results:

In total, 290 ATOs were documented (181 early, 87 late, and 22 subsequent) among 538 admissions. The most common ATO recommendations were narrow therapy (148 of 290), no change (124 of 290), and change to oral (30 of 290). ATO initiation was lower in the UC ATO-B group than in either ATO group (21.8% UC ATO-B vs 69.2% ATO-A and -B). Overall antibiotic use was not different between the groups (P = .51), although intravenous (IV) levofloxacin use decreased in the UC group after ATO implementation (49 DOT/1,000 PD vs 20 DOT/1,000 PD; P = .022). The ratio of oral (PO) to intravenous (IV) DOT was lower in the UC group than in any of the ATO groups (P = .032). We detected no differences in mortality, length of stay, readmission, C. difficile infection, or antibiotic adverse events.

Conclusions:

Implementation of a pharmacist-led ATO was feasible and well accepted but did not change overall antibiotic use. An ATO may promote increased use of oral antibiotics, but more effective strategies for self-stewardship are needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 11 , November 2020 , pp. 1266 - 1271
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. The preliminary data from this study were presented at IDWeek 2016, on October 28, 2016, in New Orleans, Louisiana.

References

Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients. Arch Intern Med 2003;163:972–978.CrossRefGoogle ScholarPubMed
Davey, P, Brown, E, Charani, E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013;4:CD003543.Google Scholar
Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website.https://www.cdc.gov/antibiotic-use/core-elements/hospital.html. Published 2019. Accessed July 20, 2020.Google Scholar
Lee, TC, Frenette, C, Jayaraman, D, Green, L, Pilote, L. Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial use. Ann Intern Med 2014;161:S53–S58.CrossRefGoogle ScholarPubMed
Thom, KA, Tamma, PD, Harris, AD, et al. Impact of a prescriber-driven antibiotic time-out on antibiotic use in hospitalized patients. Clin Infect Dis 2018;68:1581–1584.CrossRefGoogle Scholar
Richardson, Sr, Neuner, EA, Athans, V, et al. Evaluation of an antimicrobial time-out on antimicrobial utilization at a large health system. Infect Control Hosp Epidemiol 2019;40:807–809.CrossRefGoogle Scholar
Bellomo, R, Ronco, C, Kellum, JA, Mehta, RL, Palevsky, P, Acute Dialysis Quality Initiative workgroup. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;4;R204–R212.CrossRefGoogle Scholar
Dunn, K, O’Reilly, A, Silke, B, Rogers, T, Bergin, C. Implementing a pharmacist-led sequential antimicrobial therapy strategy: a controlled before-and-after study. Int J Clin Pharm 2011;33:208–214.CrossRefGoogle ScholarPubMed
Kuti, JL, Le, TN, Nightingale, CH, Nicolau, DP, Quintiliani, R. Pharmacoeconomics of a pharmacist-managed program for automatically converting levofloxacin route from IV to oral. Am J Health Syst Pharm 2002;59:2209–2215.CrossRefGoogle Scholar
Banerjee, R, Teng, CB, Cunningham, SA, et al. Randomized trial of rapid multiplex polymerase chain reaction–based blood culture identification and susceptibility testing. Clin Infect Dis 2015;61:1071–1080.CrossRefGoogle ScholarPubMed
Beganovic, M, Costello, M, Wieczorkiewicz, SM. Effect of matrix-assisted laser desorption ionized-time of flight mass spectrometry (MALDI-TOF-MS) alone versus MALDI-TOF-MS combined with real-time antimicrobial stewardship intervention on time to optimal antimicrobial therapy in patients with positive blood cultures. J Clin Micro 2017;55:1437–1445.CrossRefGoogle ScholarPubMed
Weiss, CH, Moazed, F, Mcevoy, CA, et al. Prompting physicians to address a daily checklist and process of care and clinical outcomes. Am J Respir Crit Care Med 2011;184:680–686.CrossRefGoogle ScholarPubMed
Weiss, CH, Dibardino, D, Rho, J, Sung, N, Collander, B, Wunderink, RG. A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization. Crit Care Med 2013;41:2563–2569.CrossRefGoogle ScholarPubMed
Freeman, T, Eschenauer, G, Patel, T, et al. Evaluating the need for antibiotic stewardship prospective audit and feedback on weekends. Infect Control Hosp Epidemiol 2017;38:1262–1263.CrossRefGoogle ScholarPubMed
Graber, CJ, Jones, MM, Glassman, PA, et al. Taking an antibiotic time-out: utilization and usability of a self-stewardship time-out program for renewal of vancomycin and piperacillin-tazobactam. Hosp Pharm 2015;50(11):1011–1024.CrossRefGoogle ScholarPubMed
Anderson, DJ, Watson, S, Moehring, RW, et al. Feasibility of core antimicrobial stewardship interventions in community hospitals. JAMA Netw Open 2019;2(8):e199369.CrossRefGoogle ScholarPubMed
Hurst, AL, Child, J, Pearce, K, Palmer, C, Todd, JK, Parker, SK. Handshake stewardship: a highly effective rounding-based antimicrobial optimization service. Pediatr Infect Dis J 2016;35:1104–1110.CrossRefGoogle ScholarPubMed
Supplementary material: File

Van Schooneveld et al. supplementary material

Tables S1-S2

Download Van Schooneveld et al. supplementary material(File)
File 23.2 KB