title: 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, includingClostridium difficileinfection (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 = 4.4) days of therapy (DOT) per 1,000 patient days (PD) preintervention to 21.5 (SD = 6.4) DOT/1,000 PD and 4.8 (SD = 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= 0.023) and restriction (24.5 DOT/1,000 PD per month decrease;P< 0.0001) were associated with decreased utilization. In addition, the CDI rates decreased significantly (P= 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 = 2.1) preintervention to 2.2 (SD = 1.35) postrestriction. A significant increase in appropriate respiratory fluoroquinolone use occurred postrestriction versus preintervention in patients administered at least one dose (74/130 [57%] versus 74/232 [32%];P< 0.001), as well as in those receiving two or more doses (47/65 [72%] versus 67/191 [35%];P< 0.001). A significant reduction in the annual acquisition cost of moxifloxacin, the formulary respiratory fluoroquinolone, was observed postrestriction compared to preintervention within the health care system ($123,882 versus $12,273;P= 0.002). Implementation of a stewardship-initiated respiratory fluoroquinolone restriction program can increase appropriate use while reducing overall utilization, acquisition cost, and CDI rates within a health care system.
authors.affiliation: Cardinal Health, Innovative Delivery Solutions, Houston, Texas, USA kate.shea@cardinalhealth.com.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Shea
authors.affiliation: Baptist Memorial Hospital, Memphis, Tennessee, USA.
authors.forename: Athena L V
authors.initials: ALV
authors.lastname: Hobbs
authors.affiliation: Seton Healthcare Family, Austin, Texas, USA.
authors.forename: Theresa C
authors.initials: TC
authors.lastname: Jaso
authors.affiliation: Austin Infectious Diseases Consultants, Austin, Texas, USA.
authors.forename: Jack D
authors.initials: JD
authors.lastname: Bissett
authors.affiliation: University Medical Center Brackenridge, Austin, Texas, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Cruz
authors.affiliation: The University of Texas at Austin Dell Medical School, Austin, Texas, USA.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Douglass
authors.affiliation: University of Houston College of Pharmacy, Houston, Texas, USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Garey
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship / Q000379:methods*; D016360:Clostridioides difficile / Q000187:drug effects*; D003015:Clostridium Infections / Q000188:drug therapy* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D017053:Infection Control / Q000379:methods; D000077266:Moxifloxacin; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D000077266:Moxifloxacin
keywords: Clostridium difficile; antimicrobial stewardship; fluoroquinolones