68 - Impact of a Pharmacy-Driven Antimicrobial Time-out on Duration of Therapy in Community-Acquired Pneumonia

Background: Community-Acquired Pneumonia (CAP) is associated with substantial antibiotic use and potential for overprescribing.  Previous studies have demonstrated a reduction in antimicrobial exposure following implementation of provider-driven antimicrobial time-outs (ATOs).  ATOs prompt assessment of appropriateness of therapy, clinical response, and duration of therapy.  In January 2018, OSF Healthcare System implemented a 48-hour pharmacy-driven ATO in the electronic health record.  The purpose of this study was to determine if the implementation of the ATO decreased the duration of antibiotic therapy for CAP at a community hospital.

Methods: This was a retrospective chart review of adults hospitalized with CAP at OSF Saint Anthony Medical Center between May 2016 - October 2017 (pre-implementation; PRE) and April 2018 - September 2019 (post-implementation; POST).  The primary outcome was total duration of antibiotic therapy between hospitalization and discharge prescriptions.  Secondary outcomes included hospital length of stay (LOS), duration of IV therapy, and rates of treatment failure, relapse, and antibiotic-associated adverse events.

Results: A total of 808 patient charts were reviewed with 155 patients meeting inclusion criteria in both study groups.  The mean duration of antibiotic therapy was reduced by 2.14 days (PRE 10.51 days vs. POST 8.37 days; P< 0.001).  Duration of IV therapy (3.86% vs. 3.21%; P< 0.001) and 30-day emergency department visit rate (16.13% vs. 3.23%; P< 0.001) were also significantly reduced.  Differences in LOS (4.60 days vs. 4.45 days; P=0.279) and 30-day readmission rate (9.03% vs. 4.52%; P=0.114) did not meet statistical significance.  Antibiotic-associated diarrhea (28.39% vs. 17.42%; P=0.022) and acute kidney injury (17.42% vs. 6.45%; P=0.003) were significantly reduced while C. difficile infection (2.58% vs. 0.65%; P=0.371) and treatment failure (3.22% vs. 1.94%; P=0.723) only trended downward. 

Conclusion: Implementation of the pharmacy-driven ATO was associated with reduced duration of antibiotic therapy in patients hospitalized with CAP, though total durations still exceeded evidence-based recommendations.  The ATO maintained the efficacy of treatment and reduced treatment-associated adverse effects, such as diarrhea and AKI.