Following Suppression of Fluoroquinolone Susceptibilities Corrie - - PDF document
1/12/2019 Antibiotic Prescribing Trends Following Suppression of Fluoroquinolone Susceptibilities Corrie Black, Pharm D Candidate Angharad Ratliff, PharmD, BCPS, BCCCP Idaho State University/University of Alaska-Anchorage Alaska Regional
Corrie Black, Pharm D Candidate Angharad Ratliff, PharmD, BCPS, BCCCP Idaho State University/University of Alaska-Anchorage Alaska Regional Hospital
Blood sugar disturbances, including reports of hypoglycemic comas Increased risk of agitation, nervousness, memory impairment, and/or disturbances in attention Increased incidence of tendonitis or tendon rupture Increased incidence of aortic rupture or aneurysm
Blood sugar disturbances, including reports of hypoglycemic comas2 Increased risk of agitation, nervousness, memory impairment, and/or disturbances in attention2 Increased incidence of tendonitis or tendon rupture (Blackbox warning added in 2008) Increased incidence of aortic rupture or aneurysm1
January 2018, cascade reporting protocols were implemented with FQ susceptibilities suppressed if narrower, more appropriate agent susceptible Purpose of this study was to:
– Identify if FQ use decreased over a six month period after implementing – Identify alternative antibiotic use during this intervention
Enterobacteriaceae cultures Antibiotic SYSTEMIC Sample URINE Sample Ampicillin/Sulbactam REPORT REPORT Aztreonam REPORT REPORT Cefazolin (CZ) DO NOT REPORT REPORT Cefepime (FEP) DO NOT REPORT DO NOT REPORT Ceftazidime (CAZ) REPORT WHEN CRO I OR R REPORT WHEN CRO I OR R Ceftriaxone (CRO) REPORT REPORT WHEN CXM I OR R Cefuroxime (CXM) REPORT REPORT WHEN CZ I OR R Ciprofloxacin REPORT ON REQUEST REPORT ON REQUEST Gentamicin REPORT REPORT Levofloxacin REPORT WHEN CRO I/R REPORT WHEN CXM I/R Meropenem REPORT ON REQUEST OR IF I OR R REPORT ON REQUEST OR IF I OR R Piperacillin/Tazobactam REPORT WHEN CRO IS I OR R REPORT WHEN CXM IS I OR R Tobramycin REPORT IF GENT R REPORT IF GENT R Sulfamethoxazole/Trimethoprim REPORT REPORT
– Pre-post cohort comparison matched on antibiotic administration time accounting for seasonality
– Intervention data: included antibiotic use for first six months of 2018 – Control data: included antibiotic use for first six months of 2017
– Total DDD per 1,000 patient days
– Antibiotic use normalized, defined as defined daily dose (DDD) per 1,000 patient days – Percent change calculated and analyzed for statistical significance using student’s T test
– Antibiotics grouped based on spectrum of activity in secondary analysis
Between 2017 (control data) and 2018 (intervention data) there was a 32.6% reduction in FQ use, P=0.018
P=0.484 [CATEGORY NAME], [VALUE] 1st/2nd Gen Cef, -5.26% 3rd Gen Cef, -16.55% AminoPNC, -31.17% AminoPNC βLI, 3.52% Clindamycin, -22.05% Macrolides, 13.36% SMX-TMP, -9.36% Nitrofurantoin, 33.22% Pip-Tazo/ Cefepime , [VALUE]
0.00% 10.00% 20.00% 30.00% 40.00%
P=0.018 P=0.301 P=0.869 P=0.158 P=0.441 P=0.196 P=0.637 P=0.619
– Patient level data with indications was unavailable to incorporate into analysis – DDD does not provide total number of courses prescribed – Additional stewardship efforts during intervention time including:
– Increased pharmacy stewardship presence and recommendations – Order sets updated to recommend cefepime over piperacillin/tazobactam (agents grouped together to account for this)
– Suppression of FQ susceptibilities resulted in a reduction in FQ use that was statistically significant over six months – Increased use of narrower spectrum agents observed during intervention that were consistent with stewardship recommendations in place of FQ’s:
– Nitrofurantoin in uncomplicated cystitis – Macrolides in community acquired pneumonia
– Increase use of broader spectrum agents did not appear during intervention – Required minimal implementation time and daily maintenance
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