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Impact of Antibiotic Time-Outs in Multidisciplinary ICU Rounds for Antimicrobial Stewardship Program on Patient
Yuka Mishima1, Nobutoshi Nawa2, Mizuho Asada3
1Department of Intensive Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Abstract:
The antimicrobial stewardship program (ASP) is an important quality improvement initiative that is recommended in the ICU. However, the shortage of infectious disease physicians in Japan has led to the need for simpler methods for implementing ASPs. We investigated whether antibiotic time-outs (ATOs) during multidisciplinary rounds as part of an ASP can improve patient survival and reduce the number of days of therapy (DOT) with antibiotics.
Design:
Single-center controlled before-and-after study.
Setting:
Medical/surgical ICU in a tertiary university medical center in Tokyo, Japan.
Patients:
All patients 16 years old or older admitted consecutively in the ICU between October 2016 and March 2020.
Interventions:
An intensivist-driven ICU multidisciplinary round was introduced in October 2016, and ATOs with ICU rounds were implemented in June 2018. ATOs were conducted 3, 7, and 14 days after initiation of antibiotics.
Measurements And Main Results:
The primary outcome was the subdistribution hazard ratio (SHR) of survival to hospital discharge compared between multidisciplinary rounds (phase 1) and ATO during multidisciplinary rounds (phase 2) using the multivariable Fine-Gray model. The secondary outcomes were the SHR of survival to ICU discharge and the trends in the DOT with IV antibiotics per 1,000 patient-days between October 2016 and March 2020 by using interrupted time-series analysis. The number of patients in phases 1 and 2 was 777 and 796, respectively. The group that underwent ATO during multidisciplinary rounds showed a significant increase in the survival to hospital discharge in comparison with the multidisciplinary round-only group (SHR, 1.13; 95% CI, 1.02-1.25); however, the SHR of survival to ICU discharge showed no significant intergroup difference. The DOT with total IV antibiotics decreased after ATO implementation (change in intercept, -178.26; 95% CI, -317.74 to -38.78; change in slope, -7.00; 95% CI, -15.77 to 1.78).
Conclusions:
ATOs during multidisciplinary rounds are associated with improved patient survival and reduced DOT.
Insights
Implementing antibiotic time-outs (ATOs) during ICU multidisciplinary rounds improved patient survival and reduced antibiotic days of therapy (DOT). This quality improvement initiative offers a simpler approach to antimicrobial stewardship in Japan.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Healthcare Quality Improvement
Background:
- Antimicrobial stewardship programs (ASPs) are crucial for quality improvement in intensive care units (ICUs).
- Japan faces a shortage of infectious disease physicians, necessitating simpler ASP implementation methods.
- Antibiotic time-outs (ATOs) are a potential strategy to enhance ASP effectiveness.
Purpose of the Study:
- To evaluate the impact of ATOs during multidisciplinary rounds on patient survival.
- To assess the effect of ATOs on antibiotic Days of Therapy (DOT).
- To determine the feasibility of implementing ATOs as part of an ASP in an ICU setting.
Main Methods:
- A single-center controlled before-and-after study was conducted in a tertiary university medical center ICU in Tokyo, Japan.
- Patients aged 16 years or older admitted to the ICU between October 2016 and March 2020 were included.
- Intensivist-driven multidisciplinary rounds were introduced, followed by the implementation of ATOs at 3, 7, and 14 days post-antibiotic initiation.
Main Results:
- The group undergoing ATOs showed a significant increase in survival to hospital discharge (SHR, 1.13; 95% CI, 1.02-1.25).
- No significant difference in survival to ICU discharge was observed between groups.
- A decrease in total IV antibiotic DOT was noted after ATO implementation.
Conclusions:
- Antibiotic time-outs integrated into multidisciplinary rounds are associated with improved patient survival outcomes.
- ATOs contribute to the reduction of antibiotic utilization, as measured by DOT.
- This approach offers a practical method for enhancing antimicrobial stewardship in ICUs, particularly where physician resources are limited.
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