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How fluoroquinolone preauthorization affects third- and fourth-generation cephalosporin use and resistance in a large academic hospital

Published online by Cambridge University Press:  08 July 2021

Adeniyi J. Idigo ,
Matthew L. Brown ,
Howard W. Wiener ,
Russell L. Griffin ,
Yuanfan Ye ,
Amrita Mukherjee ,
Allen W. Bryan Jr ,
Rachael A. Lee  and
Sadeep Shrestha
Adeniyi J. Idigo*
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Matthew L. Brown
Affiliation:
Department of Pharmacy, University of Alabama at Birmingham Hospital, Birmingham, Alabama
Howard W. Wiener
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Russell L. Griffin
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Yuanfan Ye
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Amrita Mukherjee
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Allen W. Bryan Jr
Affiliation:
Division of Laboratory Medicine, Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Rachael A. Lee
Affiliation:
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Sadeep Shrestha
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
*
Author for correspondence: Adeniyi J. Idigo, E-mail: aidigo@uab.edu.
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Abstract

Objective:

We observed an overall increase in the use of third- and fourth-generation cephalosporins after fluoroquinolone preauthorization was implemented. We examined the change in specific third- and fourth-generation cephalosporin use, and we sought to determine whether there was a consequent change in non-susceptibility of select Gram-negative bacterial isolates to these antibiotics.

Design:

Retrospective quasi-experimental study.

Setting:

Academic hospital.

Intervention:

Fluoroquinolone preauthorization was implemented in the hospital in October 2005. We used interrupted time series (ITS) Poisson regression models to examine trends in monthly rates of ceftriaxone, ceftazidime, and cefepime use and trends in yearly rates of nonsusceptible isolates (NSIs) of select Gram-negative bacteria before (1998–2004) and after (2006–2016) fluoroquinolone preauthorization was implemented.

Results:

Rates of use of ceftriaxone and cefepime increased after fluoroquinolone preauthorization was implemented (ceftriaxone RR, 1.002; 95% CI, 1.002–1.003; P < .0001; cefepime RR, 1.003; 95% CI, 1.001–1.004; P = .0006), but ceftazidime use continued to decline (RR, 0.991, 95% CI, 0.990–0.992; P < .0001). Rates of ceftazidime and cefepime NSIs of Pseudomonas aeruginosa (ceftazidime RR, 0.937; 95% CI, 0.910–0.965, P < .0001; cefepime RR, 0.937; 95% CI, 0.912–0.963; P < .0001) declined after fluoroquinolone preauthorization was implemented. Rates of ceftazidime and cefepime NSIs of Enterobacter cloacae (ceftazidime RR, 1.116; 95% CI, 1.078–1.154; P < .0001; cefepime RR, 1.198; 95% CI, 1.112–1.291; P < .0001) and cefepime NSI of Acinetobacter baumannii (RR, 1.169; 95% CI, 1.081–1.263; P < .0001) were increasing before fluoroquinolone preauthorization was implemented but became stable thereafter: E. cloacae (ceftazidime RR, 0.987; 95% CI, 0.948–1.028; P = .531; cefepime RR, 0.990; 95% CI, 0.962–1.018; P = .461) and A. baumannii (cefepime RR, 0.972; 95% CI, 0.939–1.006; P = .100).

Conclusions:

Fluoroquinolone preauthorization may increase use of unrestricted third- and fourth-generation cephalosporins; however, we did not observe increased antimicrobial resistance to these agents, especially among clinically important Gram-negative bacteria known for hospital-acquired infections.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 7 , July 2022 , pp. 848 - 859
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Senior authors of equal contribution.

PREVIOUS PRESENTATION. Idigo AJ, Lee RA, Brown ML, etal. Impact of Fluoroquinolone Pre-authorization on Ceftriaxone Use and Resistance in a Large Academic Hospital in Southeast USA. Poster presentation at the 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management in Philadelphia, Pennsylvania, USA, on 08/28/19.

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