Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 16;2(1):e186.
doi: 10.1017/ash.2022.326. eCollection 2022.

Fluoroquinolone stewardship at a community health system: A decade in review

Elena A Swingler  1 , Matthew Song  1 , Sarah E Moore  1 , Brian C Bohn  2 , Paul S Schulz  1 , Alan D Junkins  3 , Ashley M Wilde  1
Affiliations

Fluoroquinolone stewardship at a community health system: A decade in review

Elena A Swingler et al. Antimicrob Steward Healthc Epidemiol. .

Abstract

Objective: To describe inpatient fluoroquinolone use and susceptibility data over a 10-year period after the implementation of an antimicrobial stewardship program (ASP) led by an infectious diseases pharmacist starting in 2011.

Design: Retrospective surveillance study.

Setting: Large community health system.

Methods: Fluoroquinolone use was quantified by days of therapy (DOT) per 1,000 patient days (PD) and reported quarterly. Use data are reported for inpatients from 2016 to 2020. Levofloxacin susceptibility is reported for Pseudomonas aeruginosa and Escherichia coli for inpatients from 2011 to 2020 at a 4 adult-hospital health system.

Results: Inpatient fluoroquinolone use decreased by 74% over a 5-year period, with an average decrease of 3.45 DOT per 1,000 PD per quarter (P < .001). Over a 10-year period, inpatient levofloxacin susceptibility increased by 57% for P. aeruginosa and by 15% for E. coli. P. aeruginosa susceptibility to levofloxacin increased by an average of 2.73% per year (P < .001) and had a strong negative correlation with fluoroquinolone use, r = -0.99 (P = .002). E. coli susceptibility to levofloxacin increased by an average of 1.33% per year (P < .001) and had a strong negative correlation with fluoroquinolone use, r = -0.95 (P = .015).

Conclusions: A substantial decrease in fluoroquinolone use and increase in P. aeruginosa and E. coli levofloxacin susceptibility was observed after implementation of an antimicrobial stewardship program. These results demonstrate the value of stewardship services and highlight the effectiveness of an infectious diseases pharmacist led antimicrobial stewardship program.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Fluoroquinolone use in adult inpatients from 2016 to 2020.
Fig. 2.
Fig. 2.
P. aeruginosa levofloxacin susceptibility in adult inpatients from 2010 to 2020.
Fig. 3.
Fig. 3.
E. coli levofloxacin susceptibility in adult inpatients from 2010 to 2020.
See this image and copyright information in PMC

References

    1. Antimicrobial resistance. World Health Organization website. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Published 2021. Accessed June 29, 2022.
    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. - PubMed
    1. Lautenbach E, Strom BL, Nachamkin I, et al. Longitudinal trends in fluoroquinolone resistance among Enterobacteriaceae isolates from inpatients and outpatients, 1989–2000: differences in the emergence and epidemiology of resistance across organisms. Clin Infect Dis 2004;38:655–662. - PubMed
    1. Polk RE, Johnson CK, McClish D, Wenzel RP, Edmond MB. Predicting hospital rates of fluoroquinolone-resistant Pseudomonas aeruginosa from fluoroquinolone use in US hospitals and their surrounding communities. Clin Infect Dis 2004;39:497–503. - PubMed
    1. Sanchez GV, Master RN, Karlowsky JA, Bordon JM. In vitro antimicrobial resistance of urinary Escherichia coli isolates among US outpatients from 2000 to 2010. Antimicrob Agents Chemother 2012;56:2181–2183. - PMC - PubMed

LinkOut - more resources