215. Unintended Consequences of Fluoroquinolone Stewardship: Impact on Overall Antimicrobial Use Data and Implications for Benchmarking
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
  • FQ Unintended Consequences FINAL 092518.pdf (898.3 kB)
  • Background: An antimicrobial stewardship (AS) initiative to reduce fluoroquinolone (FQ) use in targeted diagnosis-related groups (DRG) across 14 acute care hospitals was launched in 2016 due to increasing FQ resistance and FDA warnings on adverse effects (Figure 1). In community-acquired pneumonia (CAP) interventions to change prescribing from FQs to a beta-lactam (BL) + atypical agent (combo) would result in a doubling of days of therapy (DOTs) for that indication. However, combo regimens may provide patient safety and abx resistance benefits that are not captured by the DOT metric. This study examines the relationship between utilization of FQ-sparing, combo therapy for patients with CAP and associated impact on AS metrics.

    Methods: This was a retrospective, multicenter study of abx utilization for treatment of CAP before and after a FQ-sparing initiative. DRG codes identified abx use specific to CAP. Abx use was measured using medication administration reports to calculate DOT per 1000 patient days. 

    Results: The FQ initiative yielded a 40.4% reduction in overall FQ use (p<0.001), though overall abx consumption did not change (Table 1, Figure 2). A decrease in FQ use in CAP was observed (-42%, p<0.001), while combo use increased (+43%, p<0.001).

    Conclusion: A system-wide FQ-sparing initiative resulted in significant increases in use of combo abx for CAP. Although considered an appropriate intervention for patient safety and resistance reasons, unintended impacts on standard consumption metrics should be considered when comparing use within or across institutions. Use of alternative metrics, such as point-prevalence surveys, may be indicated. Examination of impact on overall DOT in additional disease states and at the facility-specific level is needed.

    Table 1: Metric Analysis




    DOT per 1000 patient days

    2016 mean ± SD

    2017 mean ± SD


    Overall utilization

    Total abx

    827.1 ± 33.3

    826.6 ± 35.3


    Total FQ

    94.7 ± 10.6

    60.3 ± 10.2


    Utilization within PNA DRGs

    FQ use

    277.9 ± 69.1

    161.2 ± 26.2


    Combo use

    605.1 ± 134.9

    865.3 ± 110.3



    278.4 ± 64.4

    385.6 ± 61.1



    234.4 ± 51.8

    265.8 ± 59.5



    92.2 ± 26.5

    213.9 ± 55.3


    FQ/Total DOT (%)




    Combo/Total DOT (%)




    SD = standard deviation 

    Sarah Green, PharmD, BCPS, Novant Health Forsyth Medical Center, Winston-Salem, NC, Ryan Chapin, PharmD, Novant Health Prince William Medical Center, Manassas, VA and The Novant Health Antimicrobial Stewardship Team


    S. Green, None

    R. Chapin, None

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