title: Impact of a Stewardship-Initiated Restriction on Empirical Use of Ciprofloxacin on Nonsusceptibility of Escherichia coli Urinary Isolates to Ciprofloxacin.
abstract: OBJECTIVE
  To evaluate the impact of a stewardship-initiated restriction on empirical use of ciprofloxacin on the nonsusceptibility of Escherichia coli urinary isolates to ciprofloxacin over time while controlling for the use of other key antibiotics with gram-negative activity.
  
  
  METHODS
  Retrospective single-center study.
  
  
  METHODS
  Large tertiary and quaternary care academic medical center.
  Of 3714 E. coli urinary isolates.
  
  
  RESULTS
  The susceptibilities of the E. coli urinary isolates to ciprofloxacin, ceftriaxone, cefepime, piperacillin-tazobactam, meropenem, trimethoprim-sulfamethoxazole, and nitrofurantoin obtained over a 7-year period (January 1, 2006-December 31, 2012) from adult inpatients were evaluated for potential relationships with antibiotic use over time by using multiple variable regression analysis. After introduction of the restriction on empirical use of ciprofloxacin in the first quarter of 2011, ciprofloxacin use declined from 141.1-39.8 defined daily doses/1000 patient-days, and the percentage of E. coli isolates that were not susceptible to ciprofloxacin decreased from 41.5-32.8%. With all antibiotics evaluated included in the model, no apparent relationships were found between the percentage of E. coli isolates nonsusceptible to ciprofloxacin and antibiotic use. However, when nonsignificant variables were eliminated (p>0.20), ciprofloxacin use was found to be positively associated with the percentage of E. coli isolates nonsusceptible to ciprofloxacin (p=0.037), whereas ceftriaxone use was negatively associated (p=0.045).
  
  
  CONCLUSIONS
  The restriction and subsequent reduction of ciprofloxacin use was found to have a positive effect on the susceptibility of E. coli urinary isolates to ciprofloxacin.
authors.affiliation: Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, Georgia.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: O'Brien
authors.affiliation: Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Jingwen
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Mauldin
authors.affiliation: Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Juanmanuel
authors.initials: J
authors.lastname: Gomez
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina Hospital, Charleston, South Carolina.
authors.forename: John M
authors.initials: JM
authors.lastname: Hurst
authors.affiliation: Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: M
authors.initials: M
authors.lastname: Sean Boger
authors.affiliation: Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.|Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, South Carolina.
authors.forename: John A
authors.initials: JA
authors.lastname: Bosso
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology* / Q000652:urine; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology* / Q000652:urine
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin
keywords: E. coli; antimicrobial resistance; stewardship; urinary tract infections