Background: Hospital costs are higher for antimicrobial resistant infections and evidence suggests that there is a link between hospital antimicrobial use and pathogen resistance.
Methods: Fluoroquinolone use and susceptibility of HO Gram negative organisms to fluoroquinolones were obtained from MedMined Surveillance Advisor (CareFusion-BD, San Diego, CA). Fluoroquinolone use was evaluated by days of therapy per 1000 days at risk from July-December 2007 and yearly through 2014. Change in fluoroquinolone susceptibilities during the same time period was evaluated for non-duplicate hospital-onset (HO) E coli (EC), K pneumonia (KP), P mirabilis (PM) and P. aeruginosa (PSA) isolates obtained from patients admitted to BLHC from July 2007 to December 31, 2014. Non-duplicate HO isolates were defined as the first isolate from a species during the 30 day period collected after day 3 of an admission or within 14 days of discharge. Pearson correlation coefficient was used to assess the relationship between fluoroquinolone use and changes in HO isolate susceptibility.
Results: Over the 7.5 year period, fluoroquinolone use decreased from 111.5 (July-Dec 2007) to 43.6 (2014) DOT/1000 DAR (-0.98, p < 0.0001). During that time period HO susceptibilities (%) were 38 and 49 (EC), 30 and 59 (KP), 37 and 64 (PM), and 53 and 55 (PSA). All correlations with fluoroquinolone reduction and improvement in susceptibilities were statistically significant as follows: -0.95 (p < 0.001) for EC, -0.95 (p < 0.001) for KP, -0.92 (p < 0.001) for PM, and -0.72 (p =0.02) for PSA.
Conclusion: We found that reduction in inpatient quinolone use is associated with significant improvements in HO quinolone susceptibilities in important gram-negative pathogens. The use of non-duplicate HO isolates is a better measure of changes in antimicrobial susceptibilities related to hospital antimicrobial use than overall inpatient isolates.
X. Sun, None
F. Petersen-Fitzpatrick, None
J. Dunne, None
P. Lao, None
F. Palmieri, None
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