Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis

Abstract

Background Fluoroquinolones (FQ) are associated with adverse effects and increasing resistance. However, uncomplicated cystitis remains a frequent reason for FQ use. Selective reporting involves withholding susceptibilities for select antimicrobial agents on microbiology reports, in hopes of dissuading use by providers. The purpose of this study was to investigate the impact of FQ susceptibility suppression on discharge prescribing for hospitalized patients with uncomplicated cystitis. Methods This was a retrospective, quasi-experimental analysis in adult patients at a 350-bed academic medical center to compare the incidence of FQ prescribing for cystitis at hospital discharge, pre- and post-implementation (March 1, 2017–March 31, 2019) of a policy to suppress FQ urinary susceptibility results for pan-susceptible Klebsiella spp. and Escherichia coli. FQ appropriateness and risk factors for FQ use were also examined. Results There was a relative risk reduction of 39% in discharge FQ prescribing when adjusted for discharge team (aRR 0.61 [CI 0.40-0.93]). Almost all FQ use was inappropriate, largely due to organisms’ susceptibility to a guideline-preferred agent (n = 61). In multivariate analysis, odds ratios of discharge FQ prescribing were 0.22 [CI 0.12-0.39] for insured patients, 0.43 [CI 0.21-0.86] for patients with antibiotic allergy, and 57.8 [CI 13.7-244] for those receiving inpatient FQ. Discharge from a medicine team was protective against discharge FQ prescribing. Conclusions Together with multidisciplinary inpatient medicine services and avoidance of inpatient FQ use, suppression of FQ susceptibilities on pan-susceptible urine isolates for Klebsiella spp. and E. coli may represent an attractive strategy for antibiotic stewardship at hospital discharge.