1850. Impact of targeted feedback on ciprofloxacin prescribing in outpatient clinic areas
Session: Poster Abstract Session: Antimicrobial Stewardship: Outpatient Settings
Saturday, October 6, 2018
Room: S Poster Hall
Background: Fluoroquinolones (FQ) have the potential for serious side effects such as tendonitis and tendon rupture, QTc prolongation, severe neuropathies, Clostridium difficile infection, dysglycemia, and AKI in patients on ACE inhibitors or ARBs. Beginning in 2016, the University of Chicago Medicine (UCM) Antibiotics Stewardship Program began to give targeted feedback and education to outpatient clinic areas regarding their FQ use to reduce the number of prescriptions.

Methods: Outpatient FQ prescribing data from July 2015-June 2016 (pre-intervention) and December 2016-December 2017 (post-intervention) was reviewed retrospectively to evaluate indications, durations and alternatives for FQ prescriptions. Education and targeted feedback specific to the clinical area on current FQ usage was given by peer-comparison or aggregate data with recommendations for improved prescribing practices. The number of ciprofloxacin prescriptions/1000 clinic visits was evaluated in 2 outpatient clinics and number of ciprofloxacin prescriptions/1000 patient discharges was evaluated in the emergency department pre and post intervention. FQ use in the two time periods was compared using the unpaired T-test.

Results: Ciprofloxacin use in the primary care group (PCG) (12.9%), student care (SC) (7.1%) and emergency department (ED) (8.6%) accounted for 28.6% of overall Ciprofloxacin use in the pre-intervention time period. A significant decrease in ciprofloxacin prescribing was seen in the PCG, 8.78Rx /1000 patient visits (PRE) vs 5.24Rx /1000 patient visits (POST), p<0.001; in SC, 16.25 Rx/1000 patient visits (PRE) vs. 6.76Rx/1000 patient visits (POST), p<0.001; and the ED, 13.37RX/1000 patient discharges (PRE) vs. 9.84/1000 patient discharges (POST) (p=0.035). Peer comparison data was well received by PCG faculty. Decreases have been sustained in each clinical area 4 (ED) to 12 months (PCG and student care) following the intervention.

Conclusion: Feedback on both aggregate clinic and individual use of ciprofloxacin resulted in decrease use in 3 outpatient clinical areas at UCM and was well received by providers. Further work is up needed to assess the most effective methods to optimize antibiotic prescribing in the ambulatory clinics.

Leona Ebara, MD, Department of Infectious Disease and Global Health, University of Chicago Medicine, Chicago, IL, Daniela Pellegrini, MD, Infectious Disease, Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL, Natasha N Pettit, PharmD, The University of Chicago Medicine, Chicago, IL and Jennifer M. Pisano, MD, Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL

Disclosures:

L. Ebara, None

D. Pellegrini, None

N. N. Pettit, None

J. M. Pisano, None

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