Shea Katherine M, Hobbs Athena L V, Jaso Theresa C, Bissett Jack D, Cruz Christopher M, Douglass Elizabeth T, Garey Kevin W
Cardinal Health, Innovative Delivery Solutions, Houston, Texas, USA
Baptist Memorial Hospital, Memphis, Tennessee, USA.
Antimicrob Agents Chemother. 2017 May 24;61(6). doi: 10.1128/AAC.00125-17. Print 2017 Jun.
Fluoroquinolones are one of the most commonly prescribed antibiotic classes in the United States despite their association with adverse consequences, including infection (CDI). We sought to evaluate the impact of a health care system antimicrobial stewardship-initiated respiratory fluoroquinolone restriction program on utilization, appropriateness of quinolone-based therapy based on institutional guidelines, and CDI rates. After implementation, respiratory fluoroquinolone utilization decreased from a monthly mean and standard deviation (SD) of 41.0 (SD = 4.4) days of therapy (DOT) per 1,000 patient days (PD) preintervention to 21.5 (SD = 6.4) DOT/1,000 PD and 4.8 (SD = 3.6) DOT/1,000 PD posteducation and postrestriction, respectively. Using segmented regression analysis, both education (14.5 DOT/1,000 PD per month decrease; = 0.023) and restriction (24.5 DOT/1,000 PD per month decrease; < 0.0001) were associated with decreased utilization. In addition, the CDI rates decreased significantly ( = 0.044) from preintervention using education (3.43 cases/10,000 PD) and restriction (2.2 cases/10,000 PD). Mean monthly CDI cases/10,000 PD decreased from 4.0 (SD = 2.1) preintervention to 2.2 (SD = 1.35) postrestriction. A significant increase in appropriate respiratory fluoroquinolone use occurred postrestriction versus preintervention in patients administered at least one dose (74/130 [57%] versus 74/232 [32%]; < 0.001), as well as in those receiving two or more doses (47/65 [72%] versus 67/191 [35%]; < 0.001). A significant reduction in the annual acquisition cost of moxifloxacin, the formulary respiratory fluoroquinolone, was observed postrestriction compared to preintervention within the health care system ($123,882 versus $12,273; = 0.002). Implementation of a stewardship-initiated respiratory fluoroquinolone restriction program can increase appropriate use while reducing overall utilization, acquisition cost, and CDI rates within a health care system.
尽管氟喹诺酮类药物会带来包括艰难梭菌感染（CDI）在内的不良后果，但它们仍是美国最常处方的抗生素类别之一。我们试图评估一项由医疗保健系统抗菌药物管理发起的呼吸道氟喹诺酮类药物限制计划对药物使用、基于机构指南的喹诺酮类治疗的合理性以及CDI发生率的影响。实施该计划后，呼吸道氟喹诺酮类药物的使用量从干预前每1000个患者日（PD）每月平均41.0（标准差[SD]=4.4）天的治疗天数（DOT）降至教育阶段后的21.5（SD = 6.4）DOT/1000 PD和限制阶段后的4.8（SD = 3.6）DOT/1000 PD。使用分段回归分析，教育（每月减少剂量14.5 DOT/1000 PD；P = 0.023）和限制（每月减少剂量24.5 DOT/1000 PD；P<0.0001）均与药物使用量减少相关。此外，使用教育措施（3.43例/10000 PD）和限制措施（2.2例/10000 PD）后，CDI发生率与干预前相比显著降低（P = 0.044）。每10000 PD的平均每月CDI病例数从干预前的4.0（SD = 2.1）降至限制措施实施后的2.2（SD = 1.35）。在至少接受一剂药物治疗的患者中，与干预前相比，限制措施实施后呼吸道氟喹诺酮类药物的合理使用显著增加（74/130[57%]对74/232[32%]；P<0.001），在接受两剂或更多剂量药物治疗的患者中也是如此（47/65[72%]对67/191[35%]；P<0.001）。与干预前相比，在医疗保健系统内，限制措施实施后观察到的处方呼吸道氟喹诺酮类药物莫西沙星的年度采购成本显著降低（123882美元对12273美元；P = 0.002）。实施由抗菌药物管理发起的呼吸道氟喹诺酮类药物限制计划可以提高合理用药水平，同时降低医疗保健系统内的总体药物使用量、采购成本和CDI发生率。
