Hayden Dillon A, White Bryan P, Neely Stephen, Bennett Kiya K
Department of Pharmacy, University of Oklahoma Medical Center, Oklahoma City, Oklahoma, USA.
College of Pharmacy, University of Oklahoma, Oklahoma City, Oklahoma, USA.
Open Forum Infect Dis. 2023 Sep 8;10(10):ofad459. doi: 10.1093/ofid/ofad459. eCollection 2023 Oct.
Fluoroquinolones (FQs) are associated with adverse effects and increasing resistance. However, uncomplicated cystitis remains a frequent reason for FQ use. Selective reporting involves withholding susceptibilities for select antimicrobial agents on microbiology reports, in hopes of dissuading use by providers. The purpose of this study was to investigate the impact of FQ susceptibility suppression on discharge prescribing for hospitalized patients with uncomplicated cystitis.
This retrospective quasi-experimental analysis was conducted among adult patients at a 350-bed academic medical center. Its aim was to compare the incidence of FQ prescribing for cystitis at hospital discharge, one year before and after implementation (1 March 2017-31 March 2019) of a policy to suppress FQ urinary susceptibility results for pansusceptible spp and . FQ appropriateness and risk factors for FQ use were also examined.
There was a relative risk reduction of 39% in discharge FQ prescribing when adjusted for discharge team (adjusted risk ratio, 0.61; 95% CI, .40-.93). Almost all FQ use was inappropriate, largely due to organisms' susceptibility to a guideline-preferred agent (n = 61). In multivariate analysis, odds ratios of discharge FQ prescribing were 0.22 (95% CI, .12-.39) for insured patients, 0.43 (95% CI, .21-.86) for patients with antibiotic allergy, and 57.8 (95% CI, 13.7-244) for those receiving inpatient FQ. Discharge from a medicine team was protective against discharge FQ prescribing.
With multidisciplinary inpatient medicine services and avoidance of inpatient FQ use, suppression of FQ susceptibilities on pansusceptible urine isolates for spp and may represent an attractive strategy for antibiotic stewardship at hospital discharge.
氟喹诺酮类药物（FQs）存在不良反应且耐药性不断增加。然而，单纯性膀胱炎仍是使用FQs的常见原因。选择性报告是指在微生物学报告中隐瞒某些抗菌药物的药敏结果，以期劝阻医疗服务提供者使用。本研究的目的是调查抑制FQ药敏结果对单纯性膀胱炎住院患者出院处方的影响。
在一家拥有350张床位的学术医疗中心对成年患者进行了这项回顾性准实验分析。其目的是比较在实施一项针对泛敏感菌抑制FQ尿液药敏结果的政策前后一年（2017年3月1日至2019年3月31日），出院时膀胱炎患者使用FQ的发生率。还检查了FQ的合理性以及使用FQ的风险因素。
在对出院团队进行调整后，出院时开具FQ处方的相对风险降低了39%（调整后的风险比为0.61；95%置信区间为0.40 - 0.93）。几乎所有FQ的使用都是不恰当的，主要是因为病原体对指南推荐药物敏感（n = 61）。在多变量分析中，参保患者出院时开具FQ处方的比值比为0.22（95%置信区间为0.12 - 0.39），有抗生素过敏的患者为0.43（95%置信区间为0.21 - 0.86），接受住院FQ治疗的患者为57.8（95%置信区间为13.7 - 244）。从内科团队出院对出院时开具FQ处方有保护作用。
通过多学科住院内科服务以及避免住院时使用FQ，对泛敏感尿液分离株的spp和抑制FQ药敏结果可能是出院时抗生素管理的一个有吸引力的策略。
