Fluoroquinolone Restriction Research Articles

Hospital-wide modification of fluoroquinolone policy and meticillin-resistant Staphylococcus aureus rates: a 10-year interrupted time-series analysis

In our tertiary university hospital, fluoroquinolones were prohibited during 2001 leading to a 90% reduction in their use. Our objective was to examine the trends in meticillin-resistant Staphylococcus aureus (MRSA) following the reintroduction of fluoroquinolones. We conducted a 10-year time-series analysis of monthly MRSA according to: (i) period of fluoroquinolone restriction (January 2001 to January 2002); (ii) period of fluoroquinolone increase up to pre-restriction levels (January 2002 to December 2004); and (iii) an observational period including the implementation of a hand hygiene campaign with alcohol-based hand rub (January 2005 to June 2009). We used segmented linear autoregression analysis to assess trends between adjacent periods. Fluoroquinolone use increased from 5.2 defined daily doses (DDD) per 1000 patient-days in 2001 to 56.6 DDD per 1000 patient-days in 2005 reaching pre-restriction fluoroquinolone levels (P<0.001) and remained stable during 2005-2010 (P=0.65). The monthly proportion of MRSA decreased during the period of FQ restriction (-0.49 per month, P<0.05). The reintroduction of fluoroquinolones was associated with a significant increase in MRSA (+0.68 per month, P<0.02) compared to the previous period. During period 3, we observed a significant change in MRSA (-5.9, P<0.002) compared to the previous period (-0.32 per month, P<0.001). During the latter period, hand hygiene was promoted and alcohol-based hand-rub consumption increased from 3411 L in 2005 to 14,599 L in 2009. This study reinforces the rationale for a hospital-wide fluoroquinolone formulary policy to control MRSA and suggests that it has an additive effect with a hand hygiene promotion.

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak. Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland. Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene. A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, -0.054; lag time, 4 months; P = .003). These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.

Fluoroquinolone Restriction in an Elderly Population

Fluoroquinolones are the most commonly prescribed antimicrobials in the U.S. Several strategies have been proposed to control their use. Now, in a

Impact of a Fluoroquinolone Restriction Policy in an Elderly Population

Background In light of growing concerns of bacterial resistance to fluoroquinolones, the province of Ontario instituted a fluoroquinolone restriction policy in March of 2001. The objective of this study was to examine the immediate impact of this policy on the rates of antibiotic prescription use and infectious disease-related hospitalizations among elderly individuals who are dispensed antibiotics. Methods An interrupted time series analysis was conducted from January 1, 1994, to March 31, 2002, using administrative health care databases covering more than 1.4 million residents of Ontario, Canada, aged 65 years and older. Population rates of antibiotic use and infectious disease-related hospitalizations within 4 weeks after an antibiotic prescription were examined using interventional autoregressive integrated moving average models. Results Immediately after the introduction of the fluoroquinolone policy, fluoroquinolone prescription rates decreased to approximately 70% of expected rates ( P < .01). Approximately 30% higher than expected use of sulfonamide ( P = .01) and urinary anti-infectives (primarily nitrofurantoin and trimethoprim; P < .01) were observed within 1 year after policy implementation. No significant changes in the use of any other groups of antibiotics were observed. Although no significant changes in the rates of overall infection-related hospital admissions among antibiotic users were observed, the rate of hospital admission for gastrointestinal infections was 32% lower than expected in the 1 year after the policy change ( P < .01). The hospital admission rate for urinary tract infections was approximately 8% higher than expected ( P < .01). Conclusions These findings suggest that formulary restrictions to fluoroquinolones can be implemented effectively to decrease use among an elderly population without adverse impact on hospital admission rates.

French fluoroquinolone restriction reduces MRSA rate

French fluoroquinolone restriction reduces MRSA rate

French fluoroquinolone restriction reduces MRSA rate

French fluoroquinolone restriction reduces MRSA rate