1850. Impact of Targeted Feedback on Ciprofloxacin Prescribing in Outpatient Clinic Areas

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 to June 2016 (pre-intervention) and December 2016 to 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/1,000 clinic visits was evaluated in two outpatient clinics and number of ciprofloxacin prescriptions/1,000 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/1,000 patient visits (PRE) vs. 5.24Rx/1,000 patient visits (POST), P < 0.001; in SC, 16.25 Rx/1,000 patient visits (PRE) vs. 6.76Rx/1,000 patient visits (POST), P < 0.001; and the ED, 13.37RX/1,000 patient discharges (PRE) vs. 9.84/1,000 patient discharges (POST) (P = 0.035). Peer comparison data were 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 three 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. DISCLOSURES: All authors: No reported disclosures.