Implementation of an Automated Antibiotic Time Out at a Comprehensive Cancer Center

Abstract

Antimicrobial stewardship programs can optimize antimicrobial use and have been federally mandated in all hospitals. However, best stewardship practices in immunocompromised patients with cancer are not well established. An antimicrobial time-out, in the form of an email, was sent to physicians caring for hospitalized patients reaching 5 days of therapy for targeted antimicrobials (daptomycin, linezolid, tigecycline, vancomycin, imipenem/cilastatin, meropenem) in a comprehensive cancer center. Physicians were to discontinue the antimicrobial if unnecessary or document a rationale for continuation. This is a quasi-experimental, interrupted time series analysis assessing antimicrobial use during the following times: Period 1 (pre time-out: 1/2007–6/2010) and Period 2 (post time-out: 7/2010 –3/2015). The primary antimicrobial consumption metric was mean duration of therapy. Days of therapy per 1,000 patient days (DOT/1000 PD) were also assessed. Implementation of the time-out was associated with a significant decrease in mean duration of therapy for the following antimicrobials; daptomycin: -0.89 d (95% CI -1.38 – -0.41); linezolid: -0.89 d (95% CI -1.27 – -0.52); meropenem: -0.97 d (95% CI -1.39 – -0.56); tigecycline: -1.41 d (95% CI -2.19 – -0.63); p < 0.001 for each comparison. DOT/1000 PD decreased significantly for meropenem (-43.49, 95% CI -58.61 – -28.37, p < 0.001), tigecycline (-35.47, 95% CI -44.94 – -26.00, p < 0.001), and daptomycin (-9.47, 95% CI -15.25 – -3.68, p = 0.002). A passive day 5 time-out was associated with reduction in targeted antibiotic use in a cancer center and could potentially be successfully adopted to several settings and electronic health records.