Ann Arbor, MI—Efforts to reduce hospital prescribing of risky antibiotics for inpatients have been successful, according to a new study that, surprisingly, also found many of those patients were prescribed the same drugs at discharge.
An article in Clinical Infectious Disease points out, in fact, that the very facilities that reported trying to reduce use of fluoroquinolones were also twice as likely to discharge patients with a new prescription for one of the drugs in that antibiotic class.
University of Michigan–led researchers note that, overall, a third of patients in their study received a fluoroquinolone prescription at the end of their hospital stay. That was despite current guidelines, which discourage fluoroquinolone use because of side effects.
Among 48 Michigan hospitals in the study, discharge-related prescriptions accounted for two-thirds of the entire fluoroquinolone supply prescribed to the nearly 12,000 patients treated for pneumonia or urinary tract infections—and made up 42% of all antibiotics prescribed at discharge.
“Fluoroquinolone antibiotics are easy to use, but carry a lot of risk for patients and society at large,” explained lead author Valerie Vaughn, MD, MSc, a hospital medicine specialist at Michigan Medicine. “These results show we need to focus on not just their use in hospitals, but also in the prescriptions that we send patients home with. Discharge prescribing is a big loophole.”
Background information in the study notes that fluoroquinolones increase the risk of Clostridium difficile infection and antibiotic resistance. As a result, it adds, hospitals often use preprescription approval or prospective audit and feedback to target fluoroquinolone prescribing.
To determine whether the strategies have an effect on aggregate fluoroquinolone use, the study looked at a 48-hospital, retrospective cohort of 11,748 general-care, medical patients hospitalized with pneumonia or positive urine culture between December 2015 and September 2017. Participants were either diagnosed with pneumonia (11,748) or had a positive urine culture (4,928).
Hospitals were surveyed on their use of preprescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing—i.e., ciprofloxacin, levofloxacin, and moxifloxacin—during hospitalization and at discharge.
With all hospitals responding to the survey, 29.2% reported using preprescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing. After adjustment, fluoroquinolone stewardship was associated with fewer patients receiving a fluoroquinolone (37.1% vs. 48.2%; P = .01) and fewer fluoroquinolone treatment days per 1,000 patients (2,282 vs. 3,096 days/1,000 patients; P = .01), which was driven by lower inpatient prescribing.
All of the news was not positive, however. Researchers determined that most (66.6%) fluoroquinolone treatment days occurred after discharge, and hospitals with fluoroquinolone stewardship had twice as many new fluoroquinolone starts after discharge as hospitals without (15.6% vs. 8.4%; P = .003).
“Hospital-based stewardship interventions targeting fluoroquinolone prescribing were associated with less fluoroquinolone prescribing during hospitalization, but not at discharge,” study authors conclude. “To limit aggregate fluoroquinolone exposure, stewardship programs should target both inpatient and discharge prescribing.”
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An article in Clinical Infectious Disease points out, in fact, that the very facilities that reported trying to reduce use of fluoroquinolones were also twice as likely to discharge patients with a new prescription for one of the drugs in that antibiotic class.
University of Michigan–led researchers note that, overall, a third of patients in their study received a fluoroquinolone prescription at the end of their hospital stay. That was despite current guidelines, which discourage fluoroquinolone use because of side effects.
Among 48 Michigan hospitals in the study, discharge-related prescriptions accounted for two-thirds of the entire fluoroquinolone supply prescribed to the nearly 12,000 patients treated for pneumonia or urinary tract infections—and made up 42% of all antibiotics prescribed at discharge.
“Fluoroquinolone antibiotics are easy to use, but carry a lot of risk for patients and society at large,” explained lead author Valerie Vaughn, MD, MSc, a hospital medicine specialist at Michigan Medicine. “These results show we need to focus on not just their use in hospitals, but also in the prescriptions that we send patients home with. Discharge prescribing is a big loophole.”
Background information in the study notes that fluoroquinolones increase the risk of Clostridium difficile infection and antibiotic resistance. As a result, it adds, hospitals often use preprescription approval or prospective audit and feedback to target fluoroquinolone prescribing.
To determine whether the strategies have an effect on aggregate fluoroquinolone use, the study looked at a 48-hospital, retrospective cohort of 11,748 general-care, medical patients hospitalized with pneumonia or positive urine culture between December 2015 and September 2017. Participants were either diagnosed with pneumonia (11,748) or had a positive urine culture (4,928).
Hospitals were surveyed on their use of preprescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing—i.e., ciprofloxacin, levofloxacin, and moxifloxacin—during hospitalization and at discharge.
With all hospitals responding to the survey, 29.2% reported using preprescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing. After adjustment, fluoroquinolone stewardship was associated with fewer patients receiving a fluoroquinolone (37.1% vs. 48.2%; P = .01) and fewer fluoroquinolone treatment days per 1,000 patients (2,282 vs. 3,096 days/1,000 patients; P = .01), which was driven by lower inpatient prescribing.
All of the news was not positive, however. Researchers determined that most (66.6%) fluoroquinolone treatment days occurred after discharge, and hospitals with fluoroquinolone stewardship had twice as many new fluoroquinolone starts after discharge as hospitals without (15.6% vs. 8.4%; P = .003).
“Hospital-based stewardship interventions targeting fluoroquinolone prescribing were associated with less fluoroquinolone prescribing during hospitalization, but not at discharge,” study authors conclude. “To limit aggregate fluoroquinolone exposure, stewardship programs should target both inpatient and discharge prescribing.”
« Click here to return to Weekly News Update.
