MUHC study examines the effect of regular re-evaluation of antibiotic use on cost and C. difficile infection rates
Resistance to antibiotics is an important health concern that affects both the spread of infections, like Clostridium difficile, and the medication budget. Researchers at the McGill University Health Centre (MUHC) examined the effectiveness of adopting an antibiotic “time-out” during treatment, which involves regularly re-evaluating the treatment strategy as the clinical situation evolves.
The study, published in this month’s issue of the Annals of Internal Medicine, showed that structured time-outs, using a locally developed online checklist, resulted in decreased antibiotic costs coupled with decreased use of targeted medications. There was also a small decline in C. difficile infections.
“According the Centers for Disease Control and Prevention (CDC) nearly 50 per cent of antibiotic use is unnecessary or inappropriate,” says first author of the study Dr. Todd Lee, MUHC attending physician and assistant professor of Medicine at McGill University. “Given this statistic, and our own concerns about antimicrobial resistance, we decided to implement a tailored time-out program at the MUHC and evaluate its effectiveness.”
Time out means clinical review
The study involved 679 patients and was conducted over a period of 18 months on the internal medicine clinical teaching units at the Montreal General Hospital of the MUHC. The time-out concept was introduced to physicians and trainees as an opportunity to review the indication, dose and duration of antibiotic use when new clinical information became available.
The staff were also educated on antibiotic guidelines and participated in a twice weekly structured review of all patients receiving antibiotics. This approach led to changes in doses, duration of treatment, and changes in the type of antibiotic prescribed, which in turn led to cost reductions and a small decrease in C. difficile.
“Our approach tied specific education about antibiotic use with a structural tool to review and guide this use,” says senior author of the study Dr. Louise Pilote, researcher at the Research Institute of the MUHC, chief of General Internal Medicine at the MUHC and a professor of medicine at McGill University. “This could translate into better prescribing practices. In general, physicians believed the process improved their comfort with antibiotics and provided clinical value.”
“We hope this approach will permit a more widespread implementation of antibiotic auditing and that this will affect future prescribing, turning today’s high rates of inappropriate antibiotic use into tomorrow’s historical footnote,” adds Dr. Lee.
About the study:
Once the embargo lifts you will find the article online at:
This paper is part of a special November supplement of the Annals of Internal Medicine supported by the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program.
This work was completed without outside funding.
The paper Antibiotic Self-stewardship: Trainee-Led Structured Antibiotic Time-outs to Improve Antimicrobial Use was co-authored by Todd C. Lee (Division of General Internal Medicine, Division of Infectious Diseases, Department of Medicine, MUHC and McGill Centre for Quality Improvement, Montreal, Canada); Charles Frenette (Division of Infectious Diseases, Department of Medicine, MUHC, Montreal, Canada); Dev Jayaraman and Laurence Green (Division of General Internal Medicine, Department of Medicine, MUHC, Montreal, Canada); and Louise Pilote (Division of General Internal Medicine, Department of Medicine, MUHC, Montreal, Canada).
• McGill University Health Centre (MUHC): muhc.ca
• Research Institute of the MUHC: rimuhc.ca
• McGill University: mcgill.ca
Public Affairs & Strategic planning
McGill University Health Centre
514 934-1934 ext. 71381
Julie Robert | McGill University Health Centre
Multi-institutional collaboration uncovers how molecular machines assemble
02.12.2016 | Salk Institute
Fertilized egg cells trigger and monitor loss of sperm’s epigenetic memory
02.12.2016 | IMBA - Institut für Molekulare Biotechnologie der Österreichischen Akademie der Wissenschaften GmbH
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water
In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...
The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.
Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
02.12.2016 | Medical Engineering
02.12.2016 | Agricultural and Forestry Science
02.12.2016 | Physics and Astronomy