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Parenteral to Oral Conversion of Fluoroquinolones: Low-Hanging Fruit for Antimicrobial Stewardship Programs?

Published online by Cambridge University Press:  02 January 2015

Makoto Jones*
Affiliation:
IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
Benedikt Huttner
Affiliation:
IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
Karl Madaras-Kelly
Affiliation:
Boise VA Medical Center, Boise, and College of Pharmacy, Idaho State University, Meridian, Idaho
Kevin Nechodom
Affiliation:
IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
Christopher Nielson
Affiliation:
VA Sierra Nevada Health Care System and University of Nevada School of Medicine, Reno, Nevada
Matthew Bidwell Goetz
Affiliation:
VA Greater LA Healthcare System and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
Melinda M. Neuhauser
Affiliation:
VA Pharmacy Benefits Management Services, Hines, Illinois
Matthew H. Samore
Affiliation:
IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
Michael A. Rubin
Affiliation:
IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
*
VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148 (makoto.jones@va.gov)

Abstract

Objective.

To estimate avoidable intravenous (IV) fluoroquinolone use in Veterans Affairs (VA) hospitals.

Design.

A retrospective analysis of bar code medication administration (BCMA) data.

Setting.

Acute care wards of 128 VA hospitals throughout the United States.

Methods.

Data were analyzed for all medications administered on acute care wards between January 1, 2006, and December 31, 2010. Patient-days receiving therapy were expressed as fluoroquinolone-days (FD) and divided into intravenous (IV; all doses administered intravenously) and oral (PO; at least one dose administered per os) FD. We assumed IV fluoroquinolone use to be potentially avoidable on a given IV FD when there was at least 1 other medication administered via the enteral route.

Results.

Over the entire study period, 884,740 IV and 830,572 PO FD were administered. Overall, avoidable IV fluoroquinolone use accounted for 46.8% of all FD and 90.9% of IV FD. Excluding the first 2 days of all IV fluoroquinolone courses and limiting the analysis to the non-ICU setting yielded more conservative estimates of avoidable IV use: 20.9% of all FD and 45.9% of IV FD. Avoidable IV use was more common for levofloxacin and more frequent in the ICU setting. There was a moderate correlation between avoidable IV FD and total systemic antibiotic use (r = 0.32).

Conclusions.

Unnecessary IV fluoroquinolone use seems to be common in the VA system, but important variations exist between facilities. Antibiotic stewardship programs could focus on this patient safety issue as a “low-hanging fruit” to increase awareness of appropriate antibiotic use.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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