Implementation of Strategies to Impact Quinolone Use: Results from a 7.5 year Evaluation from an Inner City Hospital

Background:   The CDC estimates that 30 to 50% of antibiotic usage in hospitals is unnecessary or inappropriate.  The high fluoroquinolone use identified at Bronx Grand Concourse prompted a multifaceted intervention to reduce fluoroquinolone use.

Methods: Fluoroquinolone (FQ), 3^rd/4^th generation cephalosporin (3/4 Ceph), piperacillin/tazobactam (P-T), and carbapenem (CB) use, measured as days of therapy [DOT] per 1000 days at risk [DAR]) was obtained from MedMined Surveillance Advisor (CareFusion-BD, San Diego, CA) from July-December 2007 and yearly through 2014.  The institution implemented the following FQ control strategies: (a) intravenous (IV) to oral (PO) transition with hard stop between 2010-2011, (b) UTI/pneumonia guidelines 2011-2012 and (c) analysis of antimicrobial susceptibility to combination of antibiotics 2011-2012.  Pearson correlation coefficient was used to assess the significance in antimicrobial changes.

Results:  Over the 7.5 year period, fluoroquinolone use decreased significantly from 111.5 (July-Dec 2007) to 43.6 (2014) DOT/1000 DAR (-0.98, p < 0.0001).  During that time there was a significant increase in use of 3/4 Ceph (69 to 90.7 [0.83, p < 0.001]), P-T (76.1 to 99 [0.84, p < 0.0001]), and CB (18.4 to 23.6 [0.85, p < 0.0001]).  However, combined FQ, 3/4 Ceph, P-T, and CB use was significantly lower during the study period (274.9 to 256.8 [-0.91, p < 0.0001]).

Conclusion: Multifaceted strategies to impact quinolone use at an inner city hospital resulted in a significant decrease in quinolone use and an associated decrease in broad-spectrum antimicrobial use. Such strategies can impact related antimicrobial resistance.