Antibiotic Self-stewardship: Trainee-Led Structured Antibiotic Time-outs to Improve Antimicrobial Use.

Background: Antibiotic use is an important quality improvement target. Nearly 50% of antibiotic use is unnecessary or inappropriate. To combat overuse, the Centers for Disease Control and Prevention (CDC) proposed “time-outs” to reevaluate antibiotics. Objective: To optimize antibiotic use through trainee-led time-outs. Design: Before–after study. Setting: Internal medicine (2 units, 46 beds) at a university hospital. Patients: Inpatients (n = 679). Intervention: From January 2012 until June 2013, while receiving monthly education on antimicrobial stewardship, resident physicians adjusted patients' antibiotic therapy through twice-weekly time-out audits using a structured electronic checklist. Measurements: Antibiotic costs were standardized and compared in the year before and after the audits. Use was measured as World Health Organization defined daily doses (DDDs) per 1000 patient-days. Total antibiotic use and the use of moxifloxacin, carbapenems, antipseudomonal penicillins, and vancomycin were compared by using interrupted time series. Rates of nosocomial Clostridium difficile infection were compared by using incidence rate ratios. Results: Total costs in the units decreased from $149 743CAD (January 2011 to January 2012) to $80 319 (January 2012 to January 2013), for a savings of $69 424 (46% reduction). Of the savings, $54 150 (78%) was related to carbapenems and $15 274 (22%) was due to other antibiotic classes. Adherence with the auditing process was 80%. In the time-series analyses, the only reliable and statistically significant change was a reduction in the rate of moxifloxicin use, by −1.9 DDDs per 1000 patient-days per month (95% CI, −3.8 to −0.02; P = 0.048). Rates of C. difficile infection decreased from 24.2 to 19.6 per 10 000 patient-days (incidence rate ratio, 0.8 [CI, 0.5 to 1.3]). Limitation: Other temporal factors may confound the findings. Conclusions: An antibiotic self-stewardship bundle to implement the CDC's suggested time-outs seems to have reduced overall costs and targeted antibiotic use. [ABSTRACT FROM AUTHOR]