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70. Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis

BACKGROUND: Fluoroquinolones (FQ) are associated with multiple adverse effects and increasing resistance. Acute uncomplicated cystitis (AUC) treatment remains a frequent reason for FQ use. Previous data suggests that suppression of FQ susceptibility results can decrease inpatient use, but may not re...

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Autores principales: Hayden, Dillon, White, Bryan, Neely, Stephen, Bennett, Kiya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777648/
http://dx.doi.org/10.1093/ofid/ofaa439.115
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author Hayden, Dillon
White, Bryan
Neely, Stephen
Bennett, Kiya
author_facet Hayden, Dillon
White, Bryan
Neely, Stephen
Bennett, Kiya
author_sort Hayden, Dillon
collection PubMed
description BACKGROUND: Fluoroquinolones (FQ) are associated with multiple adverse effects and increasing resistance. Acute uncomplicated cystitis (AUC) treatment remains a frequent reason for FQ use. Previous data suggests that suppression of FQ susceptibility results can decrease inpatient use, but may not reduce prescribing at discharge. The purpose of this study was to investigate the impact of FQ susceptibility suppression on discharge prescribing for AUC. METHODS: This was a retrospective, quasi-experimental study in adult patients at a 350-bed academic medical center. The effect of suppression of FQ susceptibilities on pan-susceptible urine isolates for Klebsiella sp. and E. coli on FQ prescribing and appropriateness at discharge was compared one year before and after the intervention, starting in March 2018. Risk factors for FQ use were also examined. Exclusion criteria included pyelonephritis, urinary hardware, pregnancy, concomitant infections treated with FQ, and organisms not susceptible to FQ. Risk ratios of FQ use were calculated for pre-/post-groups and stratified by discharging team for adjusted rates (aRR) using a Cochran-Mantel-Haenszel approach. For secondary outcomes, Chi-Square statistics and generalized regression models were used to assess odds of FQ use among variables. RESULTS: Overall discharge FQ prescribing decreased from 41.1% to 21.1% after the intervention, corresponding to a 53% lower adjusted risk (aRR 0.47 [95% CI 0.28–0.81]). One-hundred percent of FQ use was inappropriate, largely due to organism susceptibility to a guideline-preferred agent (n = 33/38). After adjusting for the intervention and clustering of discharge team, the odds of outpatient FQ use was 3.46 times higher for uninsured vs. insured patients, and 13.4 times higher among those who received FQ while inpatient. FQ Use at Discharge [Image: see text] Other Antibiotic Use [Image: see text] Risk Factors for FQ Use at Discharge [Image: see text] CONCLUSION: Suppression of FQ susceptibilities on pan-susceptible urine isolates for Klebsiella sp. and E. coli was associated with a decrease in FQ prescribing at discharge for AUC. Patients who received FQ while inpatient were 13.4 times more likely to be continued on FQ at discharge. Overall, prescribing of FQ for AUC was inappropriate, and stewardship programs should implement FQ suppression policies to improve FQ prescribing at discharge. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-77776482021-01-07 70. Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis Hayden, Dillon White, Bryan Neely, Stephen Bennett, Kiya Open Forum Infect Dis Poster Abstracts BACKGROUND: Fluoroquinolones (FQ) are associated with multiple adverse effects and increasing resistance. Acute uncomplicated cystitis (AUC) treatment remains a frequent reason for FQ use. Previous data suggests that suppression of FQ susceptibility results can decrease inpatient use, but may not reduce prescribing at discharge. The purpose of this study was to investigate the impact of FQ susceptibility suppression on discharge prescribing for AUC. METHODS: This was a retrospective, quasi-experimental study in adult patients at a 350-bed academic medical center. The effect of suppression of FQ susceptibilities on pan-susceptible urine isolates for Klebsiella sp. and E. coli on FQ prescribing and appropriateness at discharge was compared one year before and after the intervention, starting in March 2018. Risk factors for FQ use were also examined. Exclusion criteria included pyelonephritis, urinary hardware, pregnancy, concomitant infections treated with FQ, and organisms not susceptible to FQ. Risk ratios of FQ use were calculated for pre-/post-groups and stratified by discharging team for adjusted rates (aRR) using a Cochran-Mantel-Haenszel approach. For secondary outcomes, Chi-Square statistics and generalized regression models were used to assess odds of FQ use among variables. RESULTS: Overall discharge FQ prescribing decreased from 41.1% to 21.1% after the intervention, corresponding to a 53% lower adjusted risk (aRR 0.47 [95% CI 0.28–0.81]). One-hundred percent of FQ use was inappropriate, largely due to organism susceptibility to a guideline-preferred agent (n = 33/38). After adjusting for the intervention and clustering of discharge team, the odds of outpatient FQ use was 3.46 times higher for uninsured vs. insured patients, and 13.4 times higher among those who received FQ while inpatient. FQ Use at Discharge [Image: see text] Other Antibiotic Use [Image: see text] Risk Factors for FQ Use at Discharge [Image: see text] CONCLUSION: Suppression of FQ susceptibilities on pan-susceptible urine isolates for Klebsiella sp. and E. coli was associated with a decrease in FQ prescribing at discharge for AUC. Patients who received FQ while inpatient were 13.4 times more likely to be continued on FQ at discharge. Overall, prescribing of FQ for AUC was inappropriate, and stewardship programs should implement FQ suppression policies to improve FQ prescribing at discharge. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7777648/ http://dx.doi.org/10.1093/ofid/ofaa439.115 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Hayden, Dillon
White, Bryan
Neely, Stephen
Bennett, Kiya
70. Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis
title 70. Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis
title_full 70. Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis
title_fullStr 70. Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis
title_full_unstemmed 70. Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis
title_short 70. Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis
title_sort 70. impact of fluoroquinolone susceptibility suppression on discharge prescribing for acute uncomplicated cystitis
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777648/
http://dx.doi.org/10.1093/ofid/ofaa439.115
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