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Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a pre-authorization policy for fluoroquinolone use: A decade-long experience

Published online by Cambridge University Press:  09 October 2018

Rachael A. Lee Open the ORCID record for Rachael A. Lee [Opens in a new window] ,
Morgan C. Scully ,
Bernard C. Camins ,
Russell L. Griffin ,
Danielle F. Kunz ,
Stephen A. Moser ,
Craig J. Hoesley ,
Todd P. McCarty  and
Peter G. Pappas
Rachael A. Lee*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Morgan C. Scully*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Bernard C. Camins
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Russell L. Griffin
Affiliation:
Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama
Danielle F. Kunz
Affiliation:
Infectious Disease Solutions for Antimicrobial Stewardship, LLC, Birmingham, Alabama
Stephen A. Moser
Affiliation:
Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
Craig J. Hoesley
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Todd P. McCarty
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Peter G. Pappas
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
*
Authors for correspondence: Rachael A. Lee, MD, 1900 University Boulevard, THT 216, Birmingham, AL 35294. E-mail: ralee@uabmc.edu. Also, Morgan C. Scully, MD, 1900 University Boulevard, THT 229, Birmingham, AL 35294. E-mail: morganscully@uabmc.edu
Authors for correspondence: Rachael A. Lee, MD, 1900 University Boulevard, THT 216, Birmingham, AL 35294. E-mail: ralee@uabmc.edu. Also, Morgan C. Scully, MD, 1900 University Boulevard, THT 229, Birmingham, AL 35294. E-mail: morganscully@uabmc.edu
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Abstract

Objective

Due to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.

Design

Retrospective cohort.

Setting

Large academic medical center.

Methods

We performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp., Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998–2005) and the postimplementation period (2006–2016).

Results

Large rates of decline of FQ susceptibility began in 1998, particularly among P. aeruginosa, Acinetobacter spp., and E. cloacae. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to <60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for Acinetobacter spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005–1.072), E. cloacae (RR, 1.028; 95% CI, 1.013–1.044), and P. aeruginosa (RR, 1.013; 95% CI, 1.006–1.020). No significant change in susceptibility was detected for K. pneumoniae (RR, 1.002; 95% CI, 0.996–1.008), and the susceptibility for E. coli continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975–0.987).

Conclusions

A stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except E. coli. For 3 species (ie, Acinetobacter spp, E. cloacae, and P. aeruginosa), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 12 , December 2018 , pp. 1419 - 1424
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Lee RA, et al. (2018). Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a pre-authorization policy for fluoroquinolone use: A decade-long experience. Infection Control & Hospital Epidemiology 2018, 39, 1419–1424. doi: 10.1017/ice.2018.245

References

1. Linder, JA, Huang, ES, Steinman, MA, Gonzales, R, Stafford, RS. Fluoroquinolone prescribing in the United States: 1995 to 2002. Am J Med 2005;118:259–268.Google Scholar
2. Arizpe, A, Reveles, KR, Aitken, SL. Regional variation in antibiotic prescribing among medicare part D enrollees, 2013. BMC Infect Dis 2016;16:744.Google Scholar
3. Bidell, MR, Palchak, M, Mohr, J, Lodise, TP. Fluoroquinolone and third-generation-cephalosporin resistance among hospitalized patients with urinary tract infections due to Escherichia coli: Do rates vary by hospital characteristics and geographic region? Antimicrob Agents Chemother 2016;60:3170–3173.Google Scholar
4. Scheld, WM. Maintaining fluoroquinolone class efficacy: review of influencing factors. Emerg Infect Dis 2003;9:1–9.Google Scholar
5. Lautenbach, E, Fishman, NO, Bilker, WB, et al. Risk factors for fluoroquinolone resistance in nosocomial Escherichia coli and Klebsiella pneumoniae infections. Arch Intern Med 2002;162:2469–2477.Google Scholar
6. Ortega, M, Marco, F, Soriano, A, et al. Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome. J Antimicrob Chemother 2009;63:568–574.Google Scholar
7. Peña, C, Albareda, JM, Pallares, R, Pujol, M, Tubau, F, Ariza, J. Relationship between quinolone use and emergence of ciprofloxacin-resistant Escherichia coli in bloodstream infections. Antimicrob Agents Chemother 1995;39:520–524.Google Scholar
8. Huotari, K, Tarkka, E, Valtonen, V, Kolho, E. Incidence and risk factors for nosocomial infections caused by fluoroquinolone-resistant Escherichia coli . Eur J Clin Microbiol Infect Dis 2003;22:492–495.Google Scholar
9. Camins, BC, Marschall, J, DeVader, SR, Maker, DE, Hoffman, MW, Fraser, VJ. The clinical impact of fluoroquinolone resistance in patients with E. coli bacteremia. J Hosp Med 2011;6:344–349.Google Scholar
10. Lautenbach, E, Strom, BL, Bilker, WB, Patel, JB, Edelstein, PH, Fishman, NO. Epidemiological investigation of fluoroquinolone resistance in infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae . Clin Infect Dis 2001;33:1288–1294.Google Scholar
11. Camins, BC, King, MD, Wells, JB, et al. Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: a randomized controlled trial. Infect Control Hosp Epidemiol 2009;30:931–938.Google Scholar
12. Johannsson, B, Beekmann, SE, Srinivasan, A, Hersh, AL, Laxminarayan, R, Polgreen, PM. Improving antimicrobial stewardship: the evolution of programmatic strategies and barriers. Infect Control Hosp Epidemiol 2011;32:367–374.Google Scholar
13. Livermore, DM, Hope, R, Reynolds, R, Blackburn, R, Johnson, AP, Woodford, N. Declining cephalosporin and fluoroquinolone non-susceptibility among bloodstream Enterobacteriaceae from the UK: Links to prescribing change? J Antimicrob Chemother 2013;68:2667–2674.Google Scholar
14. Vernaz, N, Huttner, B, Muscionico, D, et al. Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community. J Antimicrob Chemother 2011;66:928–935.Google Scholar
15. MacDougall, C, Powell, JP, Johnson, CK, Edmond, MB, Polk, RE. Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and Escherichia coli in 17 US hospitals. Clin Infect Dis 2005;41:435–440.Google Scholar
16. Gallini, A, Degris, E, Desplas, M, et al. Influence of fluoroquinolone consumption in inpatients and outpatients on ciprofloxacin-resistant Escherichia coli in a university hospital. J Antimicrob Chemother 2010;65:2650–2657.Google Scholar
17. Eom, J-S, Hwang, B-Y, Sohn, J-W, et al. Clinical and molecular epidemiology of quinolone-resistant Escherichia coli isolated from urinary tract infection. Microb Drug Resist Larchmt 2002;8:227–234.Google Scholar
18. Sarma, JB, Marshall, B, Cleeve, V, Tate, D, Oswald, T, Woolfrey, S. Effects of fluoroquinolone restriction (from 2007 to 2012) on resistance in Enterobacteriaceae: interrupted time-series analysis. J Hosp Infect 2015;91:68–73.Google Scholar
19. Stapleton, PJ, Lundon, DJ, McWade, R, et al. Antibiotic resistance patterns of Escherichia coli urinary isolates and comparison with antibiotic consumption data over 10 years, 2005–2014. Ir J Med Sci 2017;186:733–741.Google Scholar
20. Guo, W, He, Q, Wang, Z, et al. Influence of antimicrobial consumption on gram-negative bacteria in inpatients receiving antimicrobial resistance therapy from 2008 to 2013 at a tertiary hospital in Shanghai, China. Am J Infect Control 2015;43:358–364.Google Scholar
21. Wong-Beringer, A, Nguyen, LH, Lee, M, Shriner, KA, Pallares, J. An antimicrobial stewardship program with a focus on reducing fluoroquinolone overuse. Pharmacotherapy 2009;29:736–743.Google Scholar
22. Boel, J, Andreasen, V, Jarløv, JO, et al. Impact of antibiotic restriction on resistance levels of Escherichia coli: a controlled interrupted time series study of a hospital-wide antibiotic stewardship programme. J Antimicrob Chemother 2016;71:2047–2051.Google Scholar
23. O’Brien, KA, Zhang, J, Mauldin, PD, et al. Impact of a stewardship-initiated restriction on empirical use of ciprofloxacin on nonsusceptibility of Escherichia coli urinary isolates to ciprofloxacin. Pharmacotherapy 2015;35:464–469.Google Scholar
24. Wu, H-H, Liu, H-Y, Lin, Y-C, Hsueh, P-R, Lee, Y-J. Correlation between levofloxacin consumption and the incidence of nosocomial infections due to fluoroquinolone-resistant Escherichia coli . Wei Mian Yu Gan Ran Za Zhi (J Microbiol Immunol Infect) 2016;49:424–429.Google Scholar
25. Langford, BJ, Seah, J, Chan, A, Downing, M, Johnstone, J, Matukas, LM. Antimicrobial Stewardship in the microbiology laboratory: impact of selective susceptibility reporting on ciprofloxacin utilization and susceptibility of gram-negative isolates to ciprofloxacin in a hospital setting. J Clin Microbiol 2016;54:2343–2347.Google Scholar
26. White, AC, Atmar, RL, Wilson, J, Cate, TR, Stager, CE, Greenberg, SB. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230–239.Google Scholar
27. Cook, PP, Das, TD, Gooch, M, Catrou, PG. Effect of a program to reduce hospital ciprofloxacin use on nosocomial Pseudomonas aeruginosa susceptibility to quinolones and other antimicrobial agents. Infect Control Hosp Epidemiol 2008;29:716–722.Google Scholar
28. Dalhoff, A. Global fluoroquinolone resistance epidemiology and implictions for clinical use. Interdiscip Perspect Infect Dis 2012;2012:976273.Google Scholar
29. Thaden, JT, Fowler, VG, Sexton, DJ, Anderson, DJ. Increasing incidence of extended-spectrum β-lactamase-producing Escherichia coli in community hospitals throughout the southeastern United States. Infect Control Hosp Epidemiol 2016;37:49–54.Google Scholar
30. Gilbert, DN, Kohlhepp, SJ, Slama, KA, et al. Phenotypic resistance of Staphylococcus aureus, selected Enterobacteriaceae, and Pseudomonas aeruginosa after single and multiple in vitro exposures to ciprofloxacin, levofloxacin, and trovafloxacin. Antimicrob Agents Chemother 2001;45:883–892.Google Scholar
31. Bhavnani, SM, Callen, WA, Forrest, A, et al. Effect of fluoroquinolone expenditures on susceptibility of Pseudomonas aeruginosa to ciprofloxacin in US hospitals. Am J Health-Syst Pharm 2003;60:1962–1970.Google Scholar