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2250. Fluoroquinolone Stewardship at a Veterans Affairs Facility: A Six Year Review

BACKGROUND: Increased utilization of antibiotics leads to decreased antimicrobial susceptibility, a well-established phenomenon. Antimicrobial stewardship programs (ASP) promote appropriate prescribing of antibiotics by decreasing inappropriate use, aiming to improve patient outcomes and reducing an...

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Autores principales: Glicksberg, Jessica, Froehlich, Morgan, Creed, Mary, Psevdos, George
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678675/
http://dx.doi.org/10.1093/ofid/ofad500.1872
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author Glicksberg, Jessica
Froehlich, Morgan
Creed, Mary
Psevdos, George
author_facet Glicksberg, Jessica
Froehlich, Morgan
Creed, Mary
Psevdos, George
author_sort Glicksberg, Jessica
collection PubMed
description BACKGROUND: Increased utilization of antibiotics leads to decreased antimicrobial susceptibility, a well-established phenomenon. Antimicrobial stewardship programs (ASP) promote appropriate prescribing of antibiotics by decreasing inappropriate use, aiming to improve patient outcomes and reducing antimicrobial resistance. Fluroquinolones (FQ) are among the most prescribed antibiotics. We describe out institutional FQ use since inception of our ASP and followed the trend for susceptibility of Enterobacteriaceae and Pseudomonas METHODS: Northport Veterans Affairs Medical Center (VAMC) provides care for over 30000 Veterans in Long Island, New York, with emergency room, acute care hospital, nursing homes and outpatient clinics A Retrospective review investigated FQ use by total refills per year and by days of therapy per 1000 patient days at Northport VAMC from 2012 to 2022, along with review of local annual antibiograms focusing on ciprofloxacin susceptibility to E. coli, K. pneumoniae, P. mirabilis and P. aeruginosa. An ASP in our facility was initiated in 2016. FQs are restricted antibiotics and require approval by the infectious diseases team (attendings, fellows, pharmacist) RESULTS: Figure 1 provides the outpatient total fills per year for Ciprofloxacin, Levofloxacin, Moxifloxacin. Inpatient FQ use during the ASP years was low: Figure 2 shows the FQ inpatient use (days of therapy/1000days) from 2019 to 2022. Comparing years 2012-2016 vs 2017-2022 there was a decrease in fills of ciprofloxacin (median 604 vs. 308 fills, P: 0.009), levofloxacin (276 vs. 116, P: 0.032), and moxifloxacin (116 vs. 14, P: 0.015). By same period comparison (see figure 3), Ciprofloxacin susceptibility for E. coli ranged median 66.5% to 61.5%, P: 0.126, K. pneumoniae 67% vs. 75.5% P: 0.086, P. mirabilis 45% vs. 47.5% P: 0.451, and P. aeruginosa 63% vs. 68.5% P: 0.308 Figure 2 [Figure: see text] inpatient FQ use 2019 to 2022 Figure 3 [Figure: see text] Ciprofloxacin susceptibility trend over time [Figure: see text] CONCLUSION: There was a statistically significant decrease in the use of FQ in the outpatient setting after ASP was initiated in our facility. Although there was a trend in improvement in ciprofloxacin susceptibilities for Klebsiella, Proteus, and Pseudomonas, it was not statistically significant. Nevertheless, our results show that reducing FQ consumption can prevent worsening susceptibility trends for enteric gram negatives and Pseudomonas. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-106786752023-11-27 2250. Fluoroquinolone Stewardship at a Veterans Affairs Facility: A Six Year Review Glicksberg, Jessica Froehlich, Morgan Creed, Mary Psevdos, George Open Forum Infect Dis Abstract BACKGROUND: Increased utilization of antibiotics leads to decreased antimicrobial susceptibility, a well-established phenomenon. Antimicrobial stewardship programs (ASP) promote appropriate prescribing of antibiotics by decreasing inappropriate use, aiming to improve patient outcomes and reducing antimicrobial resistance. Fluroquinolones (FQ) are among the most prescribed antibiotics. We describe out institutional FQ use since inception of our ASP and followed the trend for susceptibility of Enterobacteriaceae and Pseudomonas METHODS: Northport Veterans Affairs Medical Center (VAMC) provides care for over 30000 Veterans in Long Island, New York, with emergency room, acute care hospital, nursing homes and outpatient clinics A Retrospective review investigated FQ use by total refills per year and by days of therapy per 1000 patient days at Northport VAMC from 2012 to 2022, along with review of local annual antibiograms focusing on ciprofloxacin susceptibility to E. coli, K. pneumoniae, P. mirabilis and P. aeruginosa. An ASP in our facility was initiated in 2016. FQs are restricted antibiotics and require approval by the infectious diseases team (attendings, fellows, pharmacist) RESULTS: Figure 1 provides the outpatient total fills per year for Ciprofloxacin, Levofloxacin, Moxifloxacin. Inpatient FQ use during the ASP years was low: Figure 2 shows the FQ inpatient use (days of therapy/1000days) from 2019 to 2022. Comparing years 2012-2016 vs 2017-2022 there was a decrease in fills of ciprofloxacin (median 604 vs. 308 fills, P: 0.009), levofloxacin (276 vs. 116, P: 0.032), and moxifloxacin (116 vs. 14, P: 0.015). By same period comparison (see figure 3), Ciprofloxacin susceptibility for E. coli ranged median 66.5% to 61.5%, P: 0.126, K. pneumoniae 67% vs. 75.5% P: 0.086, P. mirabilis 45% vs. 47.5% P: 0.451, and P. aeruginosa 63% vs. 68.5% P: 0.308 Figure 2 [Figure: see text] inpatient FQ use 2019 to 2022 Figure 3 [Figure: see text] Ciprofloxacin susceptibility trend over time [Figure: see text] CONCLUSION: There was a statistically significant decrease in the use of FQ in the outpatient setting after ASP was initiated in our facility. Although there was a trend in improvement in ciprofloxacin susceptibilities for Klebsiella, Proteus, and Pseudomonas, it was not statistically significant. Nevertheless, our results show that reducing FQ consumption can prevent worsening susceptibility trends for enteric gram negatives and Pseudomonas. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2023-11-27 /pmc/articles/PMC10678675/ http://dx.doi.org/10.1093/ofid/ofad500.1872 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Glicksberg, Jessica
Froehlich, Morgan
Creed, Mary
Psevdos, George
2250. Fluoroquinolone Stewardship at a Veterans Affairs Facility: A Six Year Review
title 2250. Fluoroquinolone Stewardship at a Veterans Affairs Facility: A Six Year Review
title_full 2250. Fluoroquinolone Stewardship at a Veterans Affairs Facility: A Six Year Review
title_fullStr 2250. Fluoroquinolone Stewardship at a Veterans Affairs Facility: A Six Year Review
title_full_unstemmed 2250. Fluoroquinolone Stewardship at a Veterans Affairs Facility: A Six Year Review
title_short 2250. Fluoroquinolone Stewardship at a Veterans Affairs Facility: A Six Year Review
title_sort 2250. fluoroquinolone stewardship at a veterans affairs facility: a six year review
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678675/
http://dx.doi.org/10.1093/ofid/ofad500.1872
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