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72-hour time-out encourages de-escalation of broad-spectrum antibiotics
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The addition of an automated 72-hour antibiotic time-out alert within the electronic medical record system at Mercy Hospital in St. Louis led to more frequent de-escalation of broad-spectrum antibiotics compared with the period before its implementation, researchers reported.
According to Jenna R. Wolfe, DO, MPH, an internist at Mercy Hospital, and colleagues, de-escalation is a “fundamental principal” of antimicrobial stewardship, and although the merits of the intervention are known, the “practice has been inconsistently applied.”
A previous study conducted within a large health system demonstrated that an EMR-based 72-hour time-out reduced the duration of antibiotic therapy, with a 21% rate of de-escalation of empiric antimicrobials.
“With growing rates of antibiotic resistance, stewardship efforts are essential,” Wolfe told Infectious Disease News. “The era of the electronic medical record offers new opportunities to automate hospital stewardship activities and integrate them with the providers' existing workflows. Our article is among the first to suggest that automated prompts for de-escalation may be effective components of stewardship programs.”
Wolfe and colleagues conducted a retrospective cohort study to assess the proportion of patients with de-escalated antibiotic therapy in 2016 — before the intervention — and in 2017 — after the intervention.
According to the study, 113 patients were included from 2016 and were known as the pre-alert group, whereas 107 patients were included from 2017 and were known as the post-alert group. The researchers reported that 85.8% of patients in the pre-alert group and 85% in the post-alert group were eligible for de-escalation by culture data.
The findings demonstrated a 55% rate of de-escalation of any broad-spectrum agents among patients in the post-alert group (95% CI, 0.3491 to 0.0488) compared with 35.1% in the pre-alert group. The de-escalation of optimal antibiotics was 13.4% in the pre-alert group and 31.9% in the post-alert group (95% CI, 0.3126 to 0.0567). Wolfe and colleagues said that the de-escalation proportions observed after the alert implementation remained consistent over the study period.
Moreover, the researchers found that patients whose course of therapy was de-escalated had fewer total antibiotic days, shorter lengths of stay and fewer antibiotic-related adverse events compared with patients whose antibiotic course was not de-escalated. However, there was no difference in the antibiotic cost per day of therapy and mortality between the two groups.
“Our study was a real-world analysis of this intervention and [we] found that automated alerts were effective in encouraging de-escalation,” Wolfe said. “Further research is needed to better understand how to format and integrate de-escalation prompts in order to maximize their impact while reducing their burden on provider workflows.” – by Marley Ghizzone
Disclosures: The authors report no relevant final disclosures.
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