Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection

Abstract

Fluoroquinolones are one of the most commonly prescribed antibiotic classes in the United States despite their association with adverse consequences, including Clostridium difficile infection (CDI). We sought to evaluate the impact of a health care system antimicrobial stewardship-initiated respiratory fluoroquinolone restriction program on utilization, appropriateness of quinolone-based therapy based on institutional guidelines, and CDI rates. After implementation, respiratory fluoroquinolone utilization decreased from a monthly mean and standard deviation (SD) of 41.0 (SD ϭ 4.4) days of therapy (DOT) per 1,000 patient days (PD) preintervention to 21.5 (SD ϭ 6.4) DOT/1,000 PD and 4.8 (SD ϭ 3.6) DOT/1,000 PD posteducation and postrestriction, respectively. Using segmented regression analysis, both education (14.5 DOT/1,000 PD per month decrease; P ϭ 0.023) and restriction (24.5 DOT/1,000 PD per month decrease; P Ͻ 0.0001) were associated with decreased utilization. In addition, the CDI rates decreased significantly (P ϭ 0.044) from preintervention using education (3.43 cases/10,000 PD) and restriction (2.2 cases/10,000 PD). Mean monthly CDI cases/10,000 PD decreased from 4.0 (SD ϭ 2.1) preintervention to 2.2 (SD ϭ 1

Impact of syndrome-specific antimicrobial stewardship interventions on use of and resistance to fluoroquinolones: An interrupted time series analysis

“…3 Moreover, recent reports suggest that fluoroquinolone restriction may be effective as a control measure for C difficile infection (CDI), in part through reduction in infections due to fluoroquinolone-resistant C difficile strains. [3][4][5][6][7][8][9][10] In many of these studies, fluoroquinolone use was reduced through formulary restrictions or revised fluoroquinolone use guidelines, often over relatively short time periods and with resultant increases in use of other antibiotic classes.…”

Impact of a multicenter stewardship‐targeted carbapenem justification requirement on the use of carbapenems in 23 hospitals

“…They found no significant difference in daily‐defined dose per 100 bed days between pre‐ and postintervention. A previous multicenter study implemented a respiratory fluoroquinolone restriction policy that educated providers on appropriate use, followed by a policy including pharmacist review of orders for consistency with approved restriction criteria . Our study expanded on this method by requiring providers to select a stewardship‐targeted justification in the order entry process.…”

Nonmodal Clinical Decision Support and Antimicrobial Restriction Effects on Rates of Fluoroquinolone Use in Uncomplicated Infections

“…Aside from CDS, many antimicrobial stewardship efforts to influence antibiotic prescribing practices have focused on restriction protocols. [9][10][11] Antimicrobial prescribing with an optimized antimicrobial stewardship program has been found to be effective in increasing compliance with institutional policies, reducing duration of antibiotic treatment, and associated with concomitant decreased levels of bacterial resistance to drug classes such as fluoroquinolones (FQs). 9,10,12 In May 2016, the U.S. Food and Drug Administration (FDA) advised restricting FQ for acute sinusitis, acute bronchitis, and uncomplicated urinary tract infection (UTI) due to disabling and potentially permanent side effects involving the tendons, muscles, joints, nerves, and central nervous system.…”

“…[9][10][11] Antimicrobial prescribing with an optimized antimicrobial stewardship program has been found to be effective in increasing compliance with institutional policies, reducing duration of antibiotic treatment, and associated with concomitant decreased levels of bacterial resistance to drug classes such as fluoroquinolones (FQs). 9,10,12 In May 2016, the U.S. Food and Drug Administration (FDA) advised restricting FQ for acute sinusitis, acute bronchitis, and uncomplicated urinary tract infection (UTI) due to disabling and potentially permanent side effects involving the tendons, muscles, joints, nerves, and central nervous system. 13 At Harnett Health System (HHS), a rural academic health care system, antimicrobial stewardship (AS) strategies at HHS include prospective audits of antimicrobial use, de-escalation of therapy based on culture and sensitivity data, dose optimization, intravenous (IV) to per os (PO) conversion, and antimicrobial restriction.…”