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Impact of a Hospital Based Antibiotic Stewardship Team on Prescribing Fluroquinolones at a Long Term Care Facility

Session: Poster Abstract Session: Clinical Practice Issues
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Overuse of fluroquinolones (FQ) in a long term care facility (LTCF) is associated with bacterial resistance and an increase incidence of Clostridium difficile infection (CDI).   A hospital based antibiotic stewardship team (H-AST) has had an impact on decreasing the use of FQs in a hospital setting, but there is limited data on the impact of a hospital based team providing educational initiatives at an off-site LTCF.  

Methods: A relationship was established between a H-AST and 520 bed LTCF.  The H-AST focused on decreasing FQ use in asymptomatic bacteriuria (AB), skin soft tissue infections (SSTI), and respiratory tract infections (RTI).   Interventions performed included: distribution of a LTCF specific UTI antibiogram, medical staff in-services, and family member education on the risk of antibiotic overuse.  Baseline data was collected monthly from 7/12 to 3/13 and intervention data was collected from 7/13 to 3/14 and compared quarterly.  FQ use was measured in defined daily doses per 1000 patient days (DDD/1000 PD).  The relative percentage of FQ use compared to total antibiotic use (FQ DDD/Total antibiotic DDD) was also determined.  Pearson’s chi-squared test was performed.  Rates of CDI, AB, SSTI, and RTI (cases/1000 PD) were collected during the baseline and intervention period.

Results: During the 9 months prior to intervention, FQ quarterly use increased 51.4% (10.3 to 15.6 DDD/1000PD). Post intervention FQ use decreased 51.9% (15.8 to 7.6 DDD/1000PD). The relative percentage of FQ use compared to total antibiotic use decreased 6% from baseline (23% to 17%) p = <0.05.   Ciprofloxacin had the greatest decline in DDD from baseline p = <0.05.  CDI rates decreased by 7.6% in the intervention period.  Infection rates of AB and RTIs decreased by 10.5% and 25% respectively and treatment rates of SSTIs increased by 11% when compared to baseline data.

Conclusion: The H-AST decreased FQ use by over 50% and significantly decreased FQ use relative to total antibiotic use at the LTCF by utilizing mainly educational initiatives.  This significant decrease in FQ usage may also have an impact on antibacterial resistance rates and CDI in the future.

Christine Rahme, Pharm.D., Pharmacy, St. Joseph Hospital Health Center, Syracuse, NY, Helen Jacoby, MD, Infectious Diseases, St. Joseph's Hospital Health Center, Syracuse, NY, Karen Whalen, BSPharm, BCPS, St. Joseph's Hospital, Baldwinsville, NY and Lisa Avery, PharmD, BCPS, Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY


C. Rahme, None

H. Jacoby, None

K. Whalen, None

L. Avery, None

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