Prevent Antibiotic overUSE (PAUSE): Impact of a Provider Driven Antibiotic-Time out on Antibiotic Use and Prescribing

BACKGROUND: Empiric antibiotic (abx) therapy is often not readdressed after clinical progress becomes apparent and the results of diagnostic studies become available. We sought to evaluate whether an antibiotic time out (ATO) by front-line clinicians after 3–5 days of abx therapy could lead to a reduction in unnecessary abx use. METHODS: A quasi-experimental study to evaluate the impact of an ATO on decreasing abx use was performed over a 6-month base period and 9-month intervention period in 11 units across 6 hospitals in the greater Maryland region was conducted. Patients who received abx for at least 3 calendar days were eligible for study inclusion. Outcomes included days of abx therapy (DOT) per admission to cohort as well as percent of patients with a change in abx regimen on day 3–5 and appropriateness of abx regimens on days 3–5. Appropriateness of abx therapy was adjudicated by infectious diseases (ID) clinicians using prespecified criteria. Regression analysis was used to compare outcomes between the base and intervention periods. RESULTS: A total of 3,448 abx courses were reviewed, including 1,541 during the base and 1,907 during the intervention period. Overall DOT per cohort admission was similar between the two periods (12.7 vs. 12.2 hospital DOT per admission in the base and intervention periods, respectively, and was not statistically significant after controlling for unit and season (P = 0.18). After adjusting for season, unit, ID consultation, and comorbidities, there was a 36% increase in the odds of changing or discontinuing abx on days 3–5 in the intervention period compared with the base period (48% vs. 54%, P < 0.05). Similarly, there was an 89% increase in the odds of receiving an appropriate abx regimen on days 3–5 in the intervention period compared with the base period (53% vs. 68%, P < 0.01). There was no difference in the rate of Clostridium difficile lab-events in the two study periods. CONCLUSION: In this multicenter study, we found that performance of an ATO by front-line providers was effective at improving the appropriateness of abx therapy 3–5 days after initiation, but did not change the amount of abx use, suggesting that additional interventions, perhaps later during hospitalization or at discharge, are needed to impact duration of abx therapy. DISCLOSURES: All authors: No reported disclosures.