Journal article
Inpatient Fluoroquinolone Stewardship Improves the Quantity and Quality of Fluoroquinolone Prescribing at Hospital Discharge: A Retrospective Analysis Among 122 Veterans Health Administration Hospitals
Clinical infectious diseases, Vol.71(5), pp.1232-1239
08/22/2020
DOI: 10.1093/cid/ciz967
PMID: 31562815
Abstract
Abstract
Background
Despite increasing awareness of harms, fluoroquinolones are still frequently prescribed to inpatients and at hospital discharge. Our goal was to describe fluoroquinolone prescribing at hospital discharge across the Veterans Health Administration (VHA) and to contrast the volume and appropriateness of fluoroquinolone prescribing across 3 antimicrobial stewardship strategy types.
Methods
We analyzed a retrospective cohort of patients hospitalized at 122 VHA acute-care hospitals during 2014–2016. Data from a mandatory VHA survey were used to identify 9 hospitals that self-reported 1 of 3 strategies for optimizing fluoroquinolone prescribing: prospective audit and feedback (PAF), restrictive policies (RP), and no strategy. Manual chart reviews to assess fluoroquinolone appropriateness at hospital discharge (ie, postdischarge) were performed across the 9 hospitals (3 hospitals and 125 cases per strategy type).
Results
There were 1.7 million patient admissions. Overall, there were 1 727 478 fluoroquinolone days of therapy (DOTs), with 674 918 (39.1%) DOTs prescribed for inpatients and 1 052 560 (60.9%) DOTs prescribed postdischarge. Among the 9 reviewed hospitals, postdischarge fluoroquinolone exposure was lower at hospitals using RP, compared to no strategy (3.8% vs 9.3%, respectively; P = .012). Postdischarge fluoroquinolones were deemed inappropriate in 154 of 375 (41.1%) patients. Fluoroquinolones were more likely to be inappropriate at hospitals without a strategy (52.8%) versus those using either RP or PAF (35.2%; P = .001).
Conclusions
In this retrospective cohort, the majority of fluoroquinolone DOTs occurred after hospital discharge. A large proportion of postdischarge fluoroquinolone prescriptions were inappropriate, especially in hospitals without a strategy to manage fluoroquinolone prescribing. Our findings suggest that stewardship efforts to minimize and improve fluoroquinolone prescribing should also focus on antimicrobial prescribing at hospital discharge.
Among Veterans Health Administration hospitals, 60% of fluoroquinolone days of therapy were prescribed at hospital discharge. Hospitals with no fluoroquinolone stewardship strategy had a significantly higher proportion of inappropriate fluoroquinolone use at hospital discharge, compared to hospitals with stewardship.
Details
- Title: Subtitle
- Inpatient Fluoroquinolone Stewardship Improves the Quantity and Quality of Fluoroquinolone Prescribing at Hospital Discharge: A Retrospective Analysis Among 122 Veterans Health Administration Hospitals
- Creators
- Hiroyuki Suzuki - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USAEli N Perencevich - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USABruce Alexander - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USABrice F Beck - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USAMichihiko Goto - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USABrian C Lund - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USARajeshwari Nair - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USADaniel J Livorsi - Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Clinical infectious diseases, Vol.71(5), pp.1232-1239
- Publisher
- Oxford University Press; US
- DOI
- 10.1093/cid/ciz967
- PMID
- 31562815
- ISSN
- 1058-4838
- eISSN
- 1537-6591
- Grant note
- name: Veterans Affairs Health Services Research and Development Service, award: CDA 16–204
- Language
- English
- Date published
- 08/22/2020
- Academic Unit
- Pharmacy; Psychiatry; Infectious Diseases; Epidemiology; Internal Medicine
- Record Identifier
- 9984001167002771
Metrics
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