Smoke Steven M, Plotkin Slava, Patel Neeki, Hilden Patrick
Pharmacy Department, Saint Barnabas Medical Center, Livingston, NJ, USA.
Pharmacy Department, Jersey City Medical Center, Jersey City, NJ, USA.
J Pharm Pract. 2022 Oct;35(5):707-710. doi: 10.1177/08971900211003447. Epub 2021 Mar 24.
Many antibiotic stewardship programs have sought to reduce fluoroquinolone use due to their association with a myriad of negative consequences. In hospital settings with fewer resources, initiatives that are less labor intensive may offer a more feasible approach to addressing fluoroquinolone use and improving patient care.
This study assessed the impact of a non-restrictive fluoroquinolone reduction initiative on antibiotic use and resistance.
This was a retrospective pre- and post-interventional ecological study conducted from 2016 to 2017. The fluoroquinolone reduction initiative consisted of education on risks and alternatives. Buttons promoting "Save the Quinolones" were also worn to increase visibility. Outcome measures were the rate of fluoroquinolone use and antibiotic resistance in Staphylococcus aureus, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Pseudomonas aeruginosa before and after the intervention.
Overall, fluoroquinolone use decreased throughout the study, but there was a significantly greater rate of decrease in the post-intervention period (monthly decrease of 3.3% (1.3, 5.1) v. 7.4% (5, 9.8) p = 0.043). S. aureus susceptibility to oxacillin increased from 47.2% to 55.2% (difference 8.0, 95%CI 1.2 to 14.7). P. aeruginosa susceptibility to levofloxacin increased from 60% to 70.7% (difference 10.7, 95%CI 0.8 to 20.6). No differences in susceptibility rates of E. coli, P. mirabilis or K. pneumoniae were detected.
This non-restrictive fluoroquinolone reduction initiative led to a significant decrease in fluoroquinolone use that was associated with decreased antibiotic resistance in S. aureus and P. aeruginosa.
由于氟喹诺酮类药物会引发众多不良后果，许多抗生素管理计划都试图减少其使用。在资源较少的医院环境中，劳动强度较小的举措可能为解决氟喹诺酮类药物的使用问题和改善患者护理提供更可行的方法。
本研究评估了一项非限制性氟喹诺酮类药物减少计划对抗生素使用和耐药性的影响。
这是一项于2016年至2017年进行的回顾性干预前后生态学研究。氟喹诺酮类药物减少计划包括关于风险和替代药物的教育。还佩戴了宣传“拯救喹诺酮类药物”的徽章以提高关注度。观察指标为干预前后金黄色葡萄球菌、大肠埃希菌、奇异变形杆菌、肺炎克雷伯菌和铜绿假单胞菌中氟喹诺酮类药物的使用比例和抗生素耐药性。
总体而言，在整个研究过程中氟喹诺酮类药物的使用量有所下降，但在干预后期下降速度明显更快（每月下降3.3%（1.3，5.1）对7.4%（5，9.8），p = 0.043）。金黄色葡萄球菌对苯唑西林的敏感性从47.2%提高到55.2%（差异8.0，95%可信区间1.2至14.7）。铜绿假单胞菌对左氧氟沙星的敏感性从60%提高到70.7%（差异10.7，95%可信区间0.8至20.6）。未检测到大肠埃希菌、奇异变形杆菌或肺炎克雷伯菌的敏感性比例有差异。
这项非限制性氟喹诺酮类药物减少计划导致氟喹诺酮类药物的使用量显著下降，这与金黄色葡萄球菌和铜绿假单胞菌抗生素耐药性的降低有关。
