1851. Impact of an Antimicrobial Stewardship Initiative on Fluoroquinolone Utilization in the Outpatient Setting at an Academic Medical Center

Abstract

Background

Fluoroquinolone (FQ) use is associated with the development of C. difficile colitis, emergence of multidrug-resistant pathogens and occurrence of multiple adverse effects. In light of these risks, the Food and Drug Administration (FDA) warns against the overuse of systemic FQs for certain infections. Utilization of clinical decision support systems or alert tools integrated within the computerized physician order entry (CPOE) have been implemented in the inpatient setting to reduce antibiotic use. However, there is limited data on the effectiveness of such strategies in the outpatient setting. The purpose of this study was to evaluate the impact of an antimicrobial stewardship initiative on FQ utilization in the outpatient setting.

Methods

This was a retrospective chart review of patients ≥18 years old who received a FQ upon discharge from the inpatient setting, emergency department or outpatient clinics at a large academic medical center. The intervention consisted of an automatic electronic alert that would appear upon prescribing of a FQ, suggesting use of an alternative antibiotic and requiring a diagnosis to be entered. The pre and post intervention periods spanned from November 16, 2016 to April 16, 2017 and from November 16, 2017 to April 16, 2018, respectively. The primary endpoint was the number of FQ prescriptions over the total number of visits in the pre- and post-intervention time periods. A secondary endpoint was days of therapy (DOT) on an FQ.

Results

1,668 patients received FQs upon discharge in the pre-intervention arm and 1,494 in the post-intervention arm. Compared with the pre-intervention group, fewer FQs were prescribed in the post intervention group (P = 0.002). Fewer patients were discharged on an FQ from the outpatient clinics in the post-intervention arm compared with the pre-intervention arm (31 vs. 39%). However, this did not hold true when evaluating the number of FQ prescriptions written from the inpatient setting (52% in the post and 42% in the pre-intervention). DOT was lower in the post-intervention arm (10,751.5) compared with the pre-intervention period (11,961).

Conclusion

Implementation of a mandatory electronic alert tool in CPOE showed a statistically significant reduction in the overall number of FQ prescriptions between the pre and post intervention groups in the outpatient setting.

Disclosures

All authors: No reported disclosures.