さまよう薬剤師のブログ

感染症治療を考える素材を提供します。最近は意思決定への応用が関心領域。双子と0歳の育児奮闘中。I have Ph.D. but less sense a ID pharmacist (ICPS). Another face is an investor.

Impact of a Prescriber-driven Antibiotic Time-out on Antibiotic Use in Hospitalized Patients

CIDに報告された、ATO研究

 

academic.oup.com

 

 一言

 

Antibiotic Time out (ATO) は、不適切治療の減少を示したけど、DOTは差がなかった。

ATOとDOTは相関しそうで相関しない報告が多いですね。

しかし、不適切治療減少に寄与できることは必要な取り組みと言えます。

プロセス評価でなく、アウトカム評価が求められますね

 

Abstract


A multicenter quasi-experimental study of a provider-driven antibiotic “time-out” in 3470 antibiotic courses showed no difference in antibiotic use before and after implementation, but did show a decrease in inappropriate therapy (45% vs 31%, P < .05). Single time-outs without input from antibiotic stewardship teams are insufficient to optimize prescribing.

 

Study Design


We performed a quasi-experimental study pre- and postim- plementation of an ATO. Preintervention data were collected during a 6-month baseline period (1 July–31 December 2014). Postintervention data were collected during a 9-month inter- vention period, in which frontline providers performed ATOs (1 April–22 December 2015).Study Design
We performed a quasi-experimental study pre- and postim- plementation of an ATO. Preintervention data were collected during a 6-month baseline period (1 July–31 December 2014). Postintervention data were collected during a 9-month inter- vention period, in which frontline providers performed ATOs (1 April–22 December 2015).

 

Intervention


A provider-driven ATO on antibiotic days 3–5 (up to 5 days postprescription allowed for review postweekend or holiday that may have otherwise been missed) was prompted by the care team on each unit during rounds without direction from research or stewardship teams. Care teams completed a paper ATO tool that included current antibiotics, indication, clinical assessment, and plan for change (Supplementary Materials). Individual patients were eligible for the intervention more than once during a hospital stay (or across multiple hospitalizations) if the trigger antibiotics were prescribed for a new indication. The ATO was not triggered based on a change in antibiotic dose or route of administration. 


Outcomes


The primary outcomes were hospital antibiotic days of ther- apy (DOT) per patient admission and total antibiotic DOT per patient admission, which included antibiotics prescribed upon hospital discharge. Secondary outcomes included the propor- tion of cases in which there was a modification or discontinu- ation of the regimen within 3–5 calendar days of onset and the appropriateness of the regimen on antibiotic days 3–5.

 

f:id:akinohanayuki:20181206054922p:plain

f:id:akinohanayuki:20181206055014p:plain

 

 

On antibiotic days 3–5, 50% (776/1541) of the antibiotic regimens were modified or discontinued in the baseline period compared with 56% (1075/1929) in the intervention period (P < .05).

 

The antibiotic prescription on antibiotic days 3–5 was adju- dicated as inappropriate in 37% of courses (1279/3470): 45% (688/1541) in the baseline period vs 31% (591/1929) in the intervention period (P < .05).