Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Infect Control Hosp Epidemiol. 2021 Nov;42(11):1361-1368. doi: 10.1017/ice.2021.10. Epub 2021 Apr 12.
To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones.
Stewardship champions at 15 hospitals were surveyed regarding the use and acceptability of strategies to improve fluoroquinolone prescribing. Antibiotic days of therapy (DOT) per 1,000 days present (DP) for sites with and without prospective audit and feedback (PAF) and/or prior approval were compared.
Among all of the sites, 60% had PAF or prior approval implemented for fluoroquinolones. Compared to sites using neither strategy (64.2 ± 34.4 DOT/DP), fluoroquinolone prescribing rates were lower for sites that employed PAF and/or prior approval (35.5 ± 9.8; P = .03) and decreased from 2017 to 2018 (P < .001). This decrease occurred without an increase in advanced-generation cephalosporins. Total antibiotic rates were 13% lower for sites with PAF and/or prior approval, but this difference did not reach statistical significance (P = .20). Sites reporting that PAF and/or prior approval were "completely" accepted had lower fluoroquinolone rates than sites where it was "moderately" accepted (34.2 ± 5.7 vs 48.7 ± 4.5; P < .01). Sites reported that clinical pathways and/or local guidelines (93%), prior approval (93%), and order forms (80%) "would" or "may" be effective in improving fluoroquinolone use. Although most sites (73%) indicated that requiring infectious disease consults would or may be effective in improving fluoroquinolones, 87% perceived implementation to be difficult.
PAF and prior approval implementation strategies focused on fluoroquinolones were associated with significantly lower fluoroquinolone prescribing rates and nonsignificant decreases in total antibiotic use, suggesting limited evidence for class substitution. The association of acceptability of strategies with lower rates highlights the importance of culture. These results may indicate increased acceptability of implementation strategies and/or sensitivity to FDA warnings.
评估以抗菌药物管理为重点的实施策略对住院患者氟喹诺酮类药物的有效性和可接受性。
对 15 家医院的抗菌药物管理专员就提高氟喹诺酮类药物处方可接受性的策略的使用和可接受性进行了调查。比较了有或没有前瞻性审核和反馈（PAF）和/或事先批准的情况下，每 1000 个治疗日（DP）的抗生素天数（DOT）。
在所有的医院中，有 60%的医院实施了氟喹诺酮类药物的 PAF 或事先批准。与既不使用也不使用这两种策略的医院（64.2±34.4DOT/DP）相比，使用 PAF 和/或事先批准的医院的氟喹诺酮类药物处方率较低（35.5±9.8；P=0.03），并且从 2017 年到 2018 年有所下降（P<0.001）。这一下降并没有导致第三代头孢菌素类药物的使用增加。使用 PAF 和/或事先批准的医院的总抗生素使用率降低了 13%，但差异无统计学意义（P=0.20）。报告称 PAF 和/或事先批准“完全”被接受的医院的氟喹诺酮类药物使用率低于报告称其“适度”被接受的医院（34.2±5.7 vs 48.7±4.5；P<0.01）。报告称，临床路径和/或当地指南（93%）、事先批准（93%）和处方单（80%）“可能”或“可能”有助于改善氟喹诺酮类药物的使用。尽管大多数医院（73%）表示，需要传染病咨询可能有助于改善氟喹诺酮类药物的使用，但 87%的医院认为实施起来有难度。
以氟喹诺酮类药物为重点的 PAF 和事先批准实施策略与氟喹诺酮类药物的处方率显著降低相关，而总抗生素使用量的减少无统计学意义，表明类替代的证据有限。策略的可接受性与较低的使用率之间的关联突出了文化的重要性。这些结果可能表明实施策略的可接受性提高，或者对 FDA 警告的敏感性增加。
