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Cited by 6Antibiotic Use and ResistanceNosocomial Infections in ICUSurgical site infection prevention

Impact of Antibiotic Time-Outs in Multidisciplinary ICU Rounds for Antimicrobial Stewardship Program on Patient Survival: A Controlled Before-and-After Study

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Mishima, Yuka, Nawa, Nobutoshi, Asada, Mizuho, Nagashima, Michio, Aiso, Yoshibumi, Nukui, Yoko, Fujiwara, Takeo, Shigemitsu, Hidenobu·2023·Critical Care Explorations
DOI 10.1097/cce.0000000000000837PMC PMC9829256
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Abstract

OBJECTIVES: The antimicrobial stewardship program (ASP) is an important quality improvement initiative that is recommended in the ICU. However, the shortage of infectious disease physicians in Japan has led to the need for simpler methods for implementing ASPs. We investigated whether antibiotic time-outs (ATOs) during multidisciplinary rounds as part of an ASP can improve patient survival and reduce the number of days of therapy (DOT) with antibiotics. DESIGN: Single-center controlled before-and-after study. SETTING: Medical/surgical ICU in a tertiary university medical center in Tokyo, Japan. PATIENTS: All patients 16 years old or older admitted consecutively in the ICU between October 2016 and March 2020. INTERVENTIONS: An intensivist-driven ICU multidisciplinary round was introduced in October 2016, and ATOs with ICU rounds were implemented in June 2018. ATOs were conducted 3, 7, and 14 days after initiation of antibiotics. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the subdistribution hazard ratio (SHR) of survival to hospital discharge compared between multidisciplinary rounds (phase 1) and ATO during multidisciplinary rounds (phase 2) using the multivariable Fine-Gray model. The secondary outcomes were the SHR of survival to ICU discharge and the trends in the DOT with IV antibiotics per 1,000 patient-days between October 2016 and March 2020 by using interrupted time-series analysis. The number of patients in phases 1 and 2 was 777 and 796, respectively. The group that underwent ATO during multidisciplinary rounds showed a significant increase in the survival to hospital discharge in comparison with the multidisciplinary round-only group (SHR, 1.13; 95% CI, 1.02–1.25); however, the SHR of survival to ICU discharge showed no significant intergroup difference. The DOT with total IV antibiotics decreased after ATO implementation (change in intercept, –178.26; 95% CI, –317.74 to –38.78; change in slope, –7.00; 95% CI, –15.77 to 1.78). CONCLUSIONS: ATOs during multidisciplinary rounds are associated with improved patient survival and reduced DOT.

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  • Multivariable models were used to compare periods, adjusting for relevant patient characteristics showing a significant difference between periods at p<0.20.

    “Multivariable models were used to compare periods, adjusting for relevant patient characteristics.”

    From Lab efficiency and improvements in the management of bloodstream infections: a before and after study (2025) · cites this paper as [7]

    The Statistical Analyses section says the authors compared phases with a Fine-Gray model that included patient characteristics, and Table 2 confirms multivariable adjustment. The supplied claim’s additional p<0.20 selection criterion is not supported: the listed predictors include characteristics with between-phase p values above 0.20 in Table 1. That criterion does not appear in the verbatim citing sentence. (LLM, conf=0.86)

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Authors
Mishima, Y., Nawa, N., Asada, M., Nagashima, M., Aiso, Y., Nukui, Y., Fujiwara, T., & Shigemitsu, H.
Affiliations
  • Tokyo Medical and Dental University (JP)
  • St. Rose Dominican Hospital (US)
Corresponding author
Shigemitsu, Hidenobu
ORCID
Venue
Critical Care Explorations
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2023-01
Volume
5
Issue
1
Pages
e0837
ISSN
2639-8028 (ISSN-L)
DOI
10.1097/cce.0000000000000837
PMC
PMC9829256
OpenAlex
W4318069164
Cited by
6
References
0
Citations by year
2026: 1 · 2025: 4 · 2023: 1
FWCI
1.15
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care Explorations (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Japan Society for the Promotion of Science (20K18844, 18K16531, 18K08911, 23K09603)
Topics
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Medicine › Surgery › Surgical site infection prevention
Keywords
antimicrobial stewardship, intensive care unit, patient survival, intravenous antibiotics, quality improvement, hospital discharge

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