Program Schedule

Antimicrobial Stewardship Strategy to Decrease Respiratory Fluoroquinolone Utilization in a Large, Urban, Healthcare System

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: To compare moxifloxacin use within a healthcare system after implementation of criteria for utilization and a required beta-lactam allergy assessment.

Methods: In 2009, the Seton Healthcare Family (central Texas) implemented antimicrobial stewardship with a primary target of reducing utilization of fluoroquinolones. This resulted in a dramatic decrease in utilization and cost (control group), as well as a decrease in C.difficile infection rates. Beginning July of 2013, the infectious diseases pharmacists led physician education regarding the healthcare system’s community acquired pneumonia treatment guideline (post-education group). Criteria for moxifloxacin use were implemented in December 2013 (post-restriction group). Pharmacists reviewed all moxifloxacin orders for approved criteria for use and performed beta-lactam allergy assessment on patients with reported allergies. To assess the effectiveness and fiscal impact of this program, descriptive statistics and a Mann-Whitney U test were used to compare moxifloxacin use and cost between the control group and the post-education and post-restriction groups.

Results: Hospital sites experienced an initial reduction in median days of therapy per 1000 patient days after education [35 (IQR 16-58) vs. 11 (IQR 10-25); p=0.076], correlating with a 23 to 63% reduction amongst individual sites. A greater reduction was experienced after implementation of criteria for use [35 (IQR16-58) vs. 6 (IQR 5-6); p=0.02], correlating with an additional reduction of 40-75% following education amongst individual sites.  As compared to education alone, the median monthly cost for moxifloxacin was further reduced following adoption of restriction criteria [$8016.14 (IQR $7518.42-$12198.01) vs. $1217.04 (IQR $0-$2900.35); p=0.01]. The annual moxifloxacin acquisition cost is expected to decrease 87% following the current restriction criteria (control $116,504.60 vs. estimated post-restriction $14,604.48; p=n/a).

Conclusion: Education provided an initial reduction in moxifloxacin utilization; however, implementation of criteria for use and a required beta-lactam allergy assessment led to a more rapid and greater reduction in utilization and expenditure.

Theresa Jaso, PharmD1, Katherine Shea, PharmD1, Mitchell Daley, PharmD1, Jack Bissett, MD2 and Elizabeth Douglass, MD3, (1)Seton Healthcare Family, Austin, TX, (2)Austin Infectious Disease Consultants, Austin, TX, (3)University of Texas Southwestern at Austin, Austin, TX


T. Jaso, None

K. Shea, None

M. Daley, None

J. Bissett, None

E. Douglass, None

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