Summary Background Fluoroquinolone (FQ) antibiotics have become a target of many antimicrobial stewardship programmes. Multiple post-marketing warnings from the Food and Drug Administration caution against use of this drug class for certain infections due to risk of harmful adverse effects outweighing benefit. Commonly employed strategies to affect antibiotic prescribing can be restrictive and without improvement in overall antibiotic appropriateness or decrease in collateral damage. Aim To develop a strategy for sustainable optimization of FQ antibiotics. Setting Multi-state health-system of 14 hospitals and medical centers. Methods The health-system antimicrobial stewardship program identified the opportunity to improve FQ utilization. In collaboration with our data and analytics team, specific targets of FQ use in pneumonia and chronic obstructive pulmonary disease were established. Face-to-face provider education and prospective audit and feedback were the mainstays of the campaign. Enhancements to the electronic medical record to support the initiative were also implemented. Findings There was an overall decrease in FQ utilization by 56.9%. For pneumonia use of FQs decreased from 16.4% to 8.1% and in COPD changed from 29.6% to 9.7% over the same time period. Conclusions A non-restrictive FQ optimization initiative based on education and feedback decreased both FQ consumption and total antibiotic use across a large multi-hospital health-system.

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BackgroundOptimal use of fluoroquinolones (FQ) is a common antimicrobial stewardship program (ASP) target based on well-cited risk for Clostridium difficile colitis and has gained national attention in the setting of recent FDA warnings about serious side effects. Identifying appropriate metrics for benchmarking poses a significant challenge. Diagnosis-related group (DRG) can be leveraged to focus large volumes of patient data to derive DRG-based days of therapy (DOT). Novant Health identified an opportunity to improve FQ use among patients with COPD and pneumonia (PNA) across the health system and created a FQ use optimization initiative based on inter-facility data that would otherwise not have been possible using the standard DOT per 1000 patient-days (PD) metric.MethodsA staged approach to optimizing FQ use was developed through a multidisciplinary, system-level ASP, and system-specific benchmarks for FQ use among patients with PNA and COPD DRGs were established. 10 facilities ranging in size from 60 to 900 beds were included in the intervention. We evaluated FQ use at the system and facility level using both standard (DOT/1000 PD) and novel metrics (DRG-specific DOT/1000 PD and percentage of antibiotic use attributed to FQ within each DRG). In addition to providing feedback on performance relative to other facilities, the intervention also included provider education and targeted infectious diseases pharmacist review and feedback.ResultsPercentage of FQ use among patients with PNA DRGs decreased from 20% to 9%, while use in COPD DRGs decreased from 38% to 12% over 15 months (55% and 68% reductions in FQ use, respectively). System-wide FQ utilization decreased by 38% over the same 15 month time period, from a peak of 114 DOT/1000 PD to 71 DOT/1000 PD.ConclusionDecreases in overall FQ utilization were influenced by DRG-specific benchmarking and inter-facility comparisons. Traditional DOT/1000 PD metrics are plagued with variance in patient characteristics (e.g., disease state variations, severity of illness). While DRG-based metrics have inherent limitations, they can provide specific data on antibiotic use patterns to support health-system specific and evidence-based benchmarking and inter-facility comparisons.Disclosures All authors: No reported disclosures.