221. Save the Quinolones! Impact of a Non-Restrictive Fluoroquinolone Reduction Initiative on Antibiotic Resistance at an Urban Teaching Hospital
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • 221_IDWeek 2018 Poster.pdf (938.2 kB)
  • Background: Use of fluoroquinolones, one of the most commonly used antibiotic classes in the United States, is associated with adverse drug events, Clostridium difficile infection and antibiotic resistance in Staphylococcus aureus and other Gram-negative bacilli. Many hospitals have instituted resource-intensive interventions to minimize fluoroquinolone use. In hospital settings with fewer resources, education and awareness campaigns offer a more feasible approach. The purpose of this study is to assess the impact of a non-restrictive fluoroquinolone reduction initiative on institutional antibiotic resistance.

    Methods: This is a retrospective pre- and post-interventional ecological study. The fluoroquinolone reduction initiative consisted of house staff education on risks of fluoroquinolone use and alternatives. Buttons promoting “Save the Quinolones” were also distributed and worn to increase visibility. The pre-intervention period and post-intervention periods were February 2016 to December 2016 and February 2017 to December 2017, respectively. The primary outcome measure was the percentage of S. aureus susceptible to oxacillin isolated before and after the intervention. Secondary outcome measures were the rate of fluoroquinolone use, and the percentages of Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Pseudomonas aeruginosa susceptible to levofloxacin. Antibiotic use data was collected as inpatient intravenous antibiotic days of therapy per 1000 patient days (DOT/1000 pt days). Chi square test was used to compare outcomes.

    Results: In the post intervention period, fluoroquinolone use decreased from 75 to 40.1 DOT/1000 pt days (-34.9, 95%CI -37.3 to -32.5, p < 0.001). S. aureus susceptibility to oxacillin increased from 47.2% to 55.2% (difference 8.0, 95%CI 1.2 to 14.7, p = 0.02). P. aeruginosa susceptibility to levofloxacin increased from 60% to 70.7% (difference 10.7, 95%CI 0.8 to 20.6, p = 0.04). No difference in susceptibility rates of E. coli, P. mirabilis or K. pneumoniae was detected.

    Conclusion: A non-restrictive fluoroquinolone reduction initiative led to a significant decrease in fluoroquinolone use. This was associated with decreased antibiotic resistance in S. aureus and P. aeruginosa.

    Steven Smoke, PharmD1, Slava Plotkin, PharmD1, Neeki Patel, PharmD1, Adriana Grigoriu, MD2 and Maria DeVivo, PharmD1, (1)Pharmacy, Jersey City Medical Center, Jersey City, NJ, (2)Medicine, Jersey City Medical Center, Jersey City, NJ

    Disclosures:

    S. Smoke, None

    S. Plotkin, None

    N. Patel, None

    A. Grigoriu, None

    M. DeVivo, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.