Dataset Information

Reductions in inpatient fluoroquinolone use and postdischarge Clostridioides difficile infection (CDI) from a systemwide antimicrobial stewardship intervention.

ABSTRACT:

Objective

To determine the impact of an inpatient stewardship intervention targeting fluoroquinolone use on inpatient and postdischarge Clostridioides difficile infection (CDI).

Design

We used an interrupted time series study design to evaluate the rate of hospital-onset CDI (HO-CDI), postdischarge CDI (PD-CDI) within 12 weeks, and inpatient fluoroquinolone use from 2 years prior to 1 year after a stewardship intervention.

Setting

An academic healthcare system with 4 hospitals.

Patients

All inpatients hospitalized between January 2017 and September 2020, excluding those discharged from locations caring for oncology, bone marrow transplant, or solid-organ transplant patients.

Intervention

Introduction of electronic order sets designed to reduce inpatient fluoroquinolone prescribing.

Results

Among 163,117 admissions, there were 683 cases of HO-CDI and 1,104 cases of PD-CDI. In the context of a 2% month-to-month decline starting in the preintervention period (P < .01), we observed a reduction in fluoroquinolone days of therapy per 1,000 patient days of 21% after the intervention (level change, P < .05). HO-CDI rates were stable throughout the study period. In contrast, we also detected a change in the trend of PD-CDI rates from a stable monthly rate in the preintervention period to a monthly decrease of 2.5% in the postintervention period (P < .01).

Conclusions

Our systemwide intervention reduced inpatient fluoroquinolone use immediately, but not HO-CDI. However, a downward trend in PD-CDI occurred. Relying on outcome measures limited to the inpatient setting may not reflect the full impact of inpatient stewardship efforts.

SUBMITTER: Jones KA

PROVIDER: S-EPMC9495417 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Reductions in inpatient fluoroquinolone use and postdischarge <i>Clostridioides difficile</i> infection (CDI) from a systemwide antimicrobial stewardship intervention.

Jones K Ashley KA Onwubiko Udodirim N UN Kubes Julianne J Albrecht Benjamin B Paciullo Kristen K Howard-Anderson Jessica J Suchindran Sujit S Trible Ronald R Jacob Jesse T JT Yi Sarah H SH Goodenough Dana D Fridkin Scott K SK Sexton Mary Elizabeth ME Wiley Zanthia Z

Antimicrobial stewardship & healthcare epidemiology : ASHE 20211022 1

<h4>Objective</h4>To determine the impact of an inpatient stewardship intervention targeting fluoroquinolone use on inpatient and postdischarge <i>Clostridioides difficile</i> infection (CDI).<h4>Design</h4>We used an interrupted time series study design to evaluate the rate of hospital-onset CDI (HO-CDI), postdischarge CDI (PD-CDI) within 12 weeks, and inpatient fluoroquinolone use from 2 years prior to 1 year after a stewardship intervention.<h4>Setting</h4>An academic healthcare system with 4 ...[more]

PMID: 36168449

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