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Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a pre-authorization policy for fluoroquinolone use: A decade-long experience

Published online by Cambridge University Press:  09 October 2018

Rachael A. Lee*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Morgan C. Scully*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Bernard C. Camins
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Russell L. Griffin
Affiliation:
Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama
Danielle F. Kunz
Affiliation:
Infectious Disease Solutions for Antimicrobial Stewardship, LLC, Birmingham, Alabama
Stephen A. Moser
Affiliation:
Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
Craig J. Hoesley
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Todd P. McCarty
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Peter G. Pappas
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
*
Authors for correspondence: Rachael A. Lee, MD, 1900 University Boulevard, THT 216, Birmingham, AL 35294. E-mail: ralee@uabmc.edu. Also, Morgan C. Scully, MD, 1900 University Boulevard, THT 229, Birmingham, AL 35294. E-mail: morganscully@uabmc.edu
Authors for correspondence: Rachael A. Lee, MD, 1900 University Boulevard, THT 216, Birmingham, AL 35294. E-mail: ralee@uabmc.edu. Also, Morgan C. Scully, MD, 1900 University Boulevard, THT 229, Birmingham, AL 35294. E-mail: morganscully@uabmc.edu

Abstract

Objective

Due to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.

Design

Retrospective cohort.

Setting

Large academic medical center.

Methods

We performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp., Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998–2005) and the postimplementation period (2006–2016).

Results

Large rates of decline of FQ susceptibility began in 1998, particularly among P. aeruginosa, Acinetobacter spp., and E. cloacae. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to <60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for Acinetobacter spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005–1.072), E. cloacae (RR, 1.028; 95% CI, 1.013–1.044), and P. aeruginosa (RR, 1.013; 95% CI, 1.006–1.020). No significant change in susceptibility was detected for K. pneumoniae (RR, 1.002; 95% CI, 0.996–1.008), and the susceptibility for E. coli continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975–0.987).

Conclusions

A stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except E. coli. For 3 species (ie, Acinetobacter spp, E. cloacae, and P. aeruginosa), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Lee RA, et al. (2018). Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a pre-authorization policy for fluoroquinolone use: A decade-long experience. Infection Control & Hospital Epidemiology 2018, 39, 1419–1424. doi: 10.1017/ice.2018.245

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