Surgeon-Led Antibiotic Time-Outs After Emergency Abdominal Surgery

Antimicrobial agent resistance caused by excessive antibiotic agent use is a critical global concern. Antibiotic agent time-outs (ATO) are recommended stewardship tools; however, their benefits after emergency abdominal operations are unproven. We evaluated whether incorporating an ATO in routine post-operative rounds could shorten the antibiotic treatment course without compromising patient outcomes.

This single-center, retrospective study included adults (aged ≥18 y) who underwent emergency operation for intra-abdominal infection at the Kyoto Medical Center between January 2017 and December 2018. From January 1, 2018, surgeons conducted daily ATOs, reassessing the indication, spectrum, and planned duration of each antimicrobial agent regimen. Segmented regression analysis was performed to compare pre- and post-intervention trends.

During the 24-month study period, 226 patients were screened, and 93 met the inclusion criteria (44 pre-intervention and 49 post-intervention). The mean duration of post-operative antibiotic agent therapy decreased from 6.7 to 5.8 days, whereas that of meropenem exposure reduced from 0.7 to 0.1 days. Interrupted time-series analysis showed an immediate 3.9-day-level decrease following ATO implementation (95% confidence interval: -8.4 to 0.6; p = 0.09). Surgical site infection rate, number of overall complications, and median length of hospital stay remained unchanged.

Surgeon-led ATOs integrated into daily rounds were associated with a shorter post-operative antimicrobial agent duration after an emergency abdominal procedure, although the reduction did not reach statistical significance. Clinical outcomes, including post-operative complications and length of stay, were not worsened. This pragmatic, low-resource intervention aligns with the goals of surgical antimicrobial agent stewardship and warrants consideration for broader implementation.