Category: Professional Posters
Purpose: In 2016, our hospital was identified as an outlier in use of fluoroquinolones and ceftaroline within our health system. The antimicrobial stewardship team focused on ensuring these antimicrobials were being used appropriately within the hospital. The team had concerns with overuse of fluroquinolones due to safety concerns associated with the class. With regards to ceftaroline, the stewardship team felt narrower spectrum therapy would be appropriate for many of the indications where it was used, and also considered that use of ceftaroline was cost prohibitive. Quinolone usage was targeted first due to the concerns for patient safety.
Methods: A baseline medication use evaluation (MUE) was performed in October 2016 to identify prescribers and ordering patterns. Appropriate indications were established by evaluating current infectious disease practice guidelines and primary literature. The MUE results were reported to the hospital’s stewardship team in February 2017. Hospitalists and emergency department physicians were the primary prescribers of fluoroquinolones, and the most common indications for use included treatment of pneumonia for levofloxacin and urinary tract infection (UTI) for ciprofloxacin. The lead hospitalist and emergency department chief both championed the initiative and assisted with prescriber education in May 2017. The prescriber education contained usage trends identified in the baseline MUE, system benchmarking, a review of the published evidence based guidelines for use and proposed internal guidelines for use. Alternative therapies were also identified and treatment pathways, highlighting the alternatives, were presented. Post implementation, periodic compliance reports and targeted education were presented to prescribers to assist with ongoing compliance. To determine the impact of the intervention, utilization was assessed before and after implementation via days of therapy per 1000 patient days (DOT/1000 PD). The process was repeated for ceftaroline with initial MUE results presented in June 2018 and education starting in July 2018, with continued post implementation monitoring.
Results: A decrease in mean DOT/1000 PD was experienced between 2016 and 2017 post-education of the appropriate uses of fluoroquinolone for both levofloxacin (30 vs. 46) and ciprofloxacin (46 vs. 55). The decrease in DOT/1000 PD was sustained for levofloxacin in both 2018 (34) and year to date (YTD) through May 2019 (29). Ciprofloxacin DOT/1000 PD continues to decrease year over year; 2018 (29) and YTD through May 2019 (25). A decrease in mean DOT/1000 PD was also experienced between 2017 and 2018 for use of ceftaroline (10 vs. 18) with further decreases seen YTD through May 2019 (6). Overall anti-infective DOT/1000 PD has trended down in the same period from 682 in 2016 to 650 YTD 2019.
Conclusion: Through targeted education of providers, we were able to correct inappropriate prescribing practices of ceftaroline and fluoroquinolones and decrease overall use of these agents. We were able to sustain the benefits of these efforts through continued education and feedback to prescribers by participating in monthly meetings and providing one on one feedback.