1851. Impact of an Antimicrobial Stewardship Initiative on Fluoroquinolone Utilization in the Outpatient Setting at an Academic Medical Center
Session: Poster Abstract Session: Antimicrobial Stewardship: Outpatient Settings
Saturday, October 6, 2018
Room: S Poster Hall
  • Antimicrobial-Stewardship-Initiative_45x60.pdf (ID Week FINAL).pdf (1.6 MB)
  • Background: Fluoroquinolone (FQ) use is associated with the development of C. difficile colitis, emergence of multi-drug resistant pathogens and occurrence of multiple adverse effects. In light of these risks, the Food and Drug Administration (FDA) warns against the overuse of systemic FQs for certain infections. Utilization of clinical decision support systems or alert tools integrated within the computerized physician order entry (CPOE) have been implemented in the inpatient setting to reduce antibiotic use. However, there is limited data on the effectiveness of such strategies in the outpatient setting. The purpose of this study is to evaluate the impact of an antimicrobial stewardship initiative on FQ utilization in the outpatient setting.

    Methods: This was a retrospective chart review of patients ≥ 18 years old who received a FQ upon discharge from the inpatient setting, emergency department or outpatient clinics at a large academic medical center. The intervention consisted of an automatic electronic alert that would appear upon prescribing of a FQ, suggesting use of an alternative antibiotic and requiring a diagnosis to be entered. The pre and post intervention periods spanned from 11/16/2016 to 4/16/2017 and from 11/16/2017 to 4/16/2018 respectively. The primary endpoint was the number of FQ prescriptions over the total number of visits in the pre and post intervention time periods. A secondary endpoint was days of therapy (DOT) on a FQ.

    Results: 1668 patients received FQs upon discharge in the pre intervention arm and 1494 in the post intervention arm. Compared to the pre-intervention group, fewer FQs were prescribed in the post intervention group (p=0.002). Fewer patients were discharged on a FQ from the outpatient clinics in the post intervention arm compared to the pre intervention arm (31 vs. 39%). However, this did not hold true when evaluating the number of FQ prescriptions written from the inpatient setting (52% in the post and 42% in the pre intervention). DOT was lower in the post intervention arm (10751.5) compared to the pre intervention period (11961).

    Conclusion: Implementation of a mandatory electronic alert tool in CPOE showed a statistically significant reduction in the overall number of FQ prescriptions between the pre and post intervention groups in the outpatient setting.

    Yousef Lafi, PharmD, Pharmacy, BronxCare Health System, Bronx, NY, Eris Cani, BS, PharmD, Pharmacy, SUNY Downstate Medical Center, Brooklyn, NY, Kyoung-Sil Kang, PharmD, BCPS, Pharmacy, Bronx Lebenon Hospital center, Bronx, NY, Aiyi Zhang, MS, Medicine, BronxCare Health System, Bronx, NY and Cosmina Zeana, MD, Infectious Diseases, BronxCare Health System, Bronx, NY


    Y. Lafi, None

    E. Cani, None

    K. S. Kang, None

    A. Zhang, None

    C. Zeana, 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.