title: Blood culture and susceptibility results and allergy history do not influence fluoroquinolone use in the treatment of community-acquired pneumonia.
abstract: OBJECTIVE
  To determine the influence of blood culture and susceptibility results and antimicrobial allergy history on fluoroquinolone use in the treatment of community-acquired pneumonia.
  
  
  METHODS
  Retrospective analysis of medical records.
  
  
  METHODS
  Centers for Medicare and Medicaid Services, Seattle, Washington.
  
  
  METHODS
  A total of 10,275 Medicare beneficiaries hospitalized with the diagnosis of pneumonia received antimicrobial treatment within 24 hours of admission. Of these patients, 288 had blood cultures positive for pneumococcus and were matched one-to-one with patients with negative blood and sputum cultures.
  
  
  RESULTS
  Antimicrobial use at the beginning and end of hospitalization, culture and susceptibility results, and patient allergies were recorded retrospectively and compared between two matched groups: patients with blood cultures positive for Streptococcus pneumoniae and those whose blood and sputum cultures were negative. Neither culture and susceptibility results nor allergy history affected the rate of fluoroquinolone use. Despite infection due to penicillin-susceptible pneumococci and no penicillin allergy, patients received therapy with fluoroquinolones (26.7%) as frequently as those with culture-negative pneumonia (34.9%; p=0.401).
  
  
  CONCLUSIONS
  Fluoroquinolones are prescribed despite microbiologic confirmation of penicillin-susceptible pneumococcal pneumonia in the absence of penicillin allergy. These prescribing patterns may contribute to selection pressure associated with fluoroquinolone-resistant gram-positive and gram-negative bacteria.
authors.affiliation: Department of Clinical Pharmacy, School of Pharmacy, University of California-San Francisco, San Francisco, California 94143, USA.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Chang
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Murray
authors.forename: Peter M
authors.initials: PM
authors.lastname: Houck
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: Claudette
authors.initials: C
authors.lastname: Greenway
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Guglielmo
mesh_terms: D001769:Blood / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D003625:Data Collection; D004342:Drug Hypersensitivity / Q000188:drug therapy / Q000276:immunology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008499:Medical Records; D008828:Microbiological Techniques / Q000379:methods; D010406:Penicillins / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use; D011018:Pneumonia, Pneumococcal / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies
chemical_list: D024841:Fluoroquinolones; D010406:Penicillins