Impact of a long-term antibiotic stewardship program targeting fluoroquinolones in a French local hospital

Abstract

IntroductionFluoroquinolones (FQs) are major antibiotics but their wide use in hospital and community settings has led to an increased bacterial resistance against this antibiotic class. We aimed to assess the efficiency of an antibiotic stewardship program targeting FQs in a local hospital, and its impact on bacterial resistance. MethodsThis observational study was conducted in the local hospital of Morteau (Franche-Comté region, East of France). The hospital has 166 beds with health and medico-social sectors and a medical home affiliated with the facility. Local guidelines on empirical treatment regimens were released in 2007 aiming to reduce the use of FQs, especially for urinary tract infections. The following monitoring indicators were assessed: total consumption of antibiotics and of FQs (DDD/1,000 hospital patient-days), and resistance to nalidixic acid among Escherichia coli strains. Changes in the number of FQ packs sold in a community pharmacy were also recorded. ResultsThe FQ consumption decreased by 85.6% between 2006 and 2015 (from 41.1 to 5.9 DDD/1,000 patient-days). The resistance to nalidixic acid among E. coli strains substantially decreased after remaining steady until 2011 (−57.2% between 2007 and 2015). The number of norfloxacin packs sold in the assessed community pharmacy decreased by 88%. ConclusionSetting up an antibiotic stewardship program in a local hospital can lead to a substantial reduction in FQ use and in E. coli resistance to FQs. It may also have a positive impact on community prescriptions.