Description:
<jats:title>Abstract</jats:title>
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<jats:title>Background</jats:title>
<jats:p>Antimicrobial stewardship programs (ASPs) can reduce the incidence of hospital-onset Clostridioides difficile infection (HO-CDI) by limiting unnecessary exposure to high-risk antibiotics, including fluoroquinolones (FQ). However, restriction policies are challenging to implement and sustain. In a mixed methods study, we explored the barriers, facilitators and efficacy of an FQ restriction policy to reduce HO-CDIs among high-risk patients.</jats:p>
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<jats:title>Methods</jats:title>
<jats:p>Our ASP instituted a pilot FQ restriction policy in our ICU and solid-organ transplant wards. We evaluated 24 months of pre- and post-intervention data, including: FQ and alternative agent use, length of stay (LOS), readmission rate, mortality and HO-CDI. We conducted 12 semi-structured interviews with front-line providers, applying the Systems Engineering Initiative for Patient Safety framework to examine perceptions of FQ use, prescribing indications, perceived relationships between FQ use and HO-CDI, and barriers imposed by FQ restrictions. Time-series analysis was performed to evaluate FQ and HO-CDI data.</jats:p>
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<jats:title>Results</jats:title>
<jats:p>FQ use decreased from an average of 111.6 days of therapy (DOT) per 1,000 patient-days pre-intervention to 19.8 DOT/1,000 patient-days (P < 0.0001). Average readmission rate, LOS on pilot units, total antibiotic use, and use of cefepime decreased after FQ restriction. Conversely, use of ceftriaxone, aminoglycosides and piperacillin–tazobactam all increased. The average HO-CDI rate was significantly lower post-intervention, although time series analysis showed a post-intervention increase in the trend in infection rate compared with the pre-intervention trend. Qualitative analysis of interviews revealed β-lactam allergy and pending discharge were barriers to FQ restriction; a patient’s history of CDI and pharmacist involvement in antimicrobial decision-making facilitated FQ restriction.</jats:p>
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<jats:title>Conclusion</jats:title>
<jats:p>An FQ restriction policy significantly decreased FQ use without adversely affecting readmission rate, LOS or mortality. Knowledge of barriers and facilitators to FQ use optimization among front-line staff can inform future successful ASP interventions. Further investigation into the effect of FQ restriction on HO-CDI is needed.</jats:p>
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<jats:title>Disclosures</jats:title>
<jats:p>Alexander Lepak, MD, Paratek Pharmaceuticals: Research Grant; Tetraphase Pharmaceuticals: Research Grant.</jats:p>
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