Antimicrobial Stewardship Strategy to Decrease Respiratory Fluoroquinolone Utilization in a Large, Urban, Healthcare System
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.
M. Daley, None
J. Bissett, None
E. Douglass, None