Room: The Pennsylvania Convention Center: IDExpo Hall BC
Between 1999 and 2005, fluoroquinolone
resistance among urinary Escherichia coli
(E. coli) isolates increased markedly at our institution following
implementation of an algorithm recommending fluoroquinolones as first line
therapy for uncomplicated cystitis (UTI).
In 2007, the algorithm was revised to direct providers to use nitrofurantoin
as first line therapy. The objectives of this study were to
evaluate changes in fluoroquinolone and nitrofurantoin prescriptions following
this intervention and assess the impact on fluoroquinolone resistance in E. coli.
This single center, retrospective study included
non-pregnant, adult outpatients diagnosed with acute cystitis and prescribed an
antibiotic from the emergency department, adult urgent care clinic, or primary
care clinic between 2003 and 2012. Changes in antibiotics prescribed for the
treatment of UTIs before and after implementation of the algorithm in 2007 and
changes in outpatient fluoroquinolone-resistant E. coli isolated from urine were evaluated over time.
5717 patients and 11,416 E.
coli isolates were included. Fluoroquinolones decreased from 65% of prescriptions
to 35% while nitrofurantoin use increased from 17% to 29% (P<0.001), with the greatest impact immediately following the
intervention. There was no further reduction in fluoroquinolone use in the
remaining post-intervention period while nitrofurantoin use had a slight but
significant downward trend. (Figure 1)
Over the course of the study period E.
coli resistance rates to fluoroquinolones increased from 1.5% to 7.6%,
however, following the decrease in fluoroquinolone use resistance rates
stabilized and decreased slightly each quarter in the post-intervention period.
(-0.3%/quarter, P = 0.02)(Figure 2) There was no change in
nitrofurantoin resistance, despite increased use.
The halt and decline of a growing population of fluoroquinolone-resistant
E. coli found in the community
followed a marked reduction in fluoroquinolone use for UTI management. Despite
increased nitrofurantoin use, there was no increase in nitrofurantoin-resistant
E. coli. These findings suggest that
antimicrobial stewardship interventions can impact the emergence of
Rebecca Seymour, PharmD1, Bryan Knepper, MPH, MSc2, Kati Shihadeh, PharmD1, Mike Doody, PharmD1, Michelle Haas, MD3 and Timothy Jenkins, MD3, (1)Acute Care Pharmacy, Denver Health Medical Center, Denver, CO, (2)Patient Safety and Quality, Denver Health Medical Center, Denver, CO, (3)Medicine/Infectious Diseases, University of Colorado-Denver Health Sciences Center, Denver, CO
None K. Shihadeh,
None M. Doody,
None M. Haas,
None T. Jenkins,