179. Evaluation of Empiric Fluoroquinolone Use in a Teaching Hospital v. Community Hospital: Are We Optimizing De-escalation? (A Pilot Study)
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Background: Fluoroquinolones have been widely used because of their broad spectrum activity and favorable safety profile.  These qualities make this class of antibiotics susceptible to increased use which is associated with increased antimicrobial resistance. In California with mandated antibiotic stewardship, prescribing broad spectrum antibiotics becomes even more germaine.

Methods:  A retrospective review was conducted at two hospitals in the San Diego area- a teaching hospital (Scripps Mercy- SM) and a community hospital (Scripps La Jolla- SL) - between October 2010 and April 2011.  Patients were selected if they were prescribed levofloxacin (LVQ) empirically, had positive cultures, and remained hospitalized until the final cultures and sensitivities (C&S) were reported.  De-escalation was defined as discontinuation or changing of LVQ to a narrower spectrum antibiotic within 3 days of the final culture. 

Results: A total of 204 patients met study criteria. Overall 109 of 204 patients (53%) were de-escalated to narrower spectrum antibiotics.  Clinicians at SM were more likely to de-escalate therapy when compared to SL (78% v. 41%, p <0.001).  SM had a higher, but not statistically significant, incidence of resistance to LVQ as compared to SL (28% v. 17%, p = 0.063).  Prescribing patterns at SM were evaluated between hospitalists and teaching teams.  Rates of de-escalation were not different at 70% v. 78% respectively (p = 0.261).  Interestingly de-escalation was 100% (21 of 21) in the intensive care unit (ICU) and 75% (54 of 72) on the medical-surgical floors (p = 0.01).

Conclusion:  In this pilot study de-escalation occurred more frequently in a teaching institution. ICU de-escalated patients 100% of the time, followed by hospitalists and house-staff. Despite greater incidence of de-escalation in a teaching facility, resistance rates between the two institutions did not differ significantly.  Further larger studies are indicated.

Subject Category: A. Antimicrobial agents and Resistance

Robert Eastin, Pharm.D.1, Amie Nguyen, Pharm.D.2, Maggie Brownell, Pharm.D.2, Donna Agan, Ed.D.1 and Harminder Sikand, PharmD1, (1)Scripps Mercy Hospital, San Diego, CA, (2)Scripps Memorial Hospital, La Jolla, CA


R. Eastin, None

A. Nguyen, None

M. Brownell, None

D. Agan, None

H. Sikand, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.