2094. Acceptability of Antibiotic Substitutions for Fluoroquinolones and Third and Fourth-generation Cephalosporins: A Report from the VA-CDC Practice-Based Research Network (PBRN)

Matthew B Goetz; Stacey Hockett Sherlock; Cassie Goedken; Erin C Balkenende; Charlesnika T Evans; Eli Perencevich; Kelly Echevarria; Sujan Reddy; Melinda M Neuhauser; Heather Reisinger; Katie J Suda

doi:10.1093/ofid/ofz360.1774

Back

2094. Acceptability of Antibiotic Substitutions for Fluoroquinolones and Third and Fourth-generation Cephalosporins: A Report from the VA-CDC Practice-Based Research Network (PBRN)

Abstract

Open access

2094. Acceptability of Antibiotic Substitutions for Fluoroquinolones and Third and Fourth-generation Cephalosporins: A Report from the VA-CDC Practice-Based Research Network (PBRN)

Matthew B Goetz, Stacey Hockett Sherlock, Cassie Goedken, Erin C Balkenende, Charlesnika T Evans, Eli Perencevich, Kelly Echevarria, Sujan Reddy, Melinda M Neuhauser, Heather Reisinger, …

Open forum infectious diseases, Vol.6(Supplement_2), pp.S708-S708

10/23/2019

DOI: 10.1093/ofid/ofz360.1774

PMCID: PMC6809126

Files and links (1)

url

https://doi.org/10.1093/ofid/ofz360.1774View

Published (Version of record) Open Access

Abstract

Abstract Background Studies suggest fluoroquinolones (FQ), and third (3C) and fourth (4C) generation cephalosporins, agents often used for empiric therapy, place patients at higher risk for C. difficile infection. Substituting alternative antibiotics for empiric therapy might reduce risk. We surveyed inpatient physician (MD) and pharmacist (PharmD) antimicrobial stewardship champions to evaluate their preferred FQ, 3C and 4C substitutions for empiric therapy. Methods Semi-structured interviews were conducted with the antimicrobial stewardship MD and the PharmD champion from each of the 15 VA-CDC Practice Based Research Network (PBRN) sites. Interviewees were asked what empiric antibiotics for pneumonia and urinary tract infections would be recommended in local guidelines if all 3C, 4C and FQ were restricted. Respondents could list multiple antibiotics. Templated data collection and analysis were used to assist in rapid analysis of interviews. Results Narrow β-lactams were identified as appropriate options for CAP by 8 MD and 9 PharmD (table). Piperacillin/tazobactam was the preferred choice by MDs and PharmDs for HCAP (7 and 12, respectively) and HAP (10 and 12, respectively). For community-onset urinary tract infections (cUTI), numerous alternatives to FQ, 3C and 4C were identified. For hospital-onset (hUTI), piperacillin/tazobactam was most frequently mentioned by MD and PharmDs (7 and 9, respectively). 4 of 5 MDs and 5 of 7 PharmDs who chose 3C for CAP indicated that 3C were preferred over all other choices for CAP, few stewards indicated that 3C were the sole preferred agents for other conditions. Conclusion Antimicrobial stewardship MD and PharmD champions were readily able to find FQ substitutions for all indications; 3C and 4C substitutions were found for all indications with a notable exception of treatment of CAP. These results suggest considerable opportunity to reduce use of these antibiotic classes. Future studies should examine the appropriateness and acceptability of the substitutions identified by stewardship champions to providers and the impact of restriction of FQ, 3C and 4C on clinical outcomes. Disclosures All authors: No reported disclosures.

Details

Title: Subtitle: 2094. Acceptability of Antibiotic Substitutions for Fluoroquinolones and Third and Fourth-generation Cephalosporins: A Report from the VA-CDC Practice-Based Research Network (PBRN)
Creators: Matthew B Goetz - VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, VA-CDC Practice-Based Research Network, Los Angeles, California
Stacey Hockett Sherlock - VA Iowa City Health Care System and University of Iowa, Iowa City, Iowa
Cassie Goedken - VA Iowa City Health Care System, Iowa City, Iowa
Erin C Balkenende - Iowa City VA Health Care System and University of Iowa, Iowa City, Iowa
Charlesnika T Evans - Northwestern University and VA, Hines, Illinois
Eli Perencevich - Iowa City VA Health Care Sysrtem and University of Iowa, Iowa City, Iowa
Kelly Echevarria - Pharmacy Benefits Management, Department of Veterans Affairs, San Antonio, Texas
Sujan Reddy - Centers for Disease Control and Prevention, Atlanta, Georgia
Melinda M Neuhauser - Centers for Disease Control and Prevention, Atlanta, Georgia
Heather Reisinger - Iowa City VAMC and University of Iowa, Iowa City, Iowa
Katie J Suda - VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, VA-CDC Practice-Based Research Network, Los Angeles, California
Resource Type: Abstract
Publication Details: Open forum infectious diseases, Vol.6(Supplement_2), pp.S708-S708
DOI: 10.1093/ofid/ofz360.1774
PMCID: PMC6809126
NLM abbreviation: Open Forum Infect Dis
ISSN: 2328-8957
eISSN: 2328-8957
Language: English
Date published: 10/23/2019
Academic Unit: Epidemiology; Center for Social Science Innovation; Internal Medicine
Record Identifier: 9984001246802771

Metrics

27 Record Views