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How fluoroquinolone preauthorization affects third- and fourth-generation cephalosporin use and resistance in a large academic hospital

Published online by Cambridge University Press:  08 July 2021

Adeniyi J. Idigo ,
Matthew L. Brown ,
Howard W. Wiener ,
Russell L. Griffin ,
Yuanfan Ye ,
Amrita Mukherjee ,
Allen W. Bryan Jr ,
Rachael A. Lee  and
Sadeep Shrestha
Adeniyi J. Idigo*
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Matthew L. Brown
Affiliation:
Department of Pharmacy, University of Alabama at Birmingham Hospital, Birmingham, Alabama
Howard W. Wiener
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Russell L. Griffin
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Yuanfan Ye
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Amrita Mukherjee
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Allen W. Bryan Jr
Affiliation:
Division of Laboratory Medicine, Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Rachael A. Lee
Affiliation:
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Sadeep Shrestha
Affiliation:
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
*
Author for correspondence: Adeniyi J. Idigo, E-mail: [email protected].
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Abstract

Objective:

We observed an overall increase in the use of third- and fourth-generation cephalosporins after fluoroquinolone preauthorization was implemented. We examined the change in specific third- and fourth-generation cephalosporin use, and we sought to determine whether there was a consequent change in non-susceptibility of select Gram-negative bacterial isolates to these antibiotics.

Design:

Retrospective quasi-experimental study.

Setting:

Academic hospital.

Intervention:

Fluoroquinolone preauthorization was implemented in the hospital in October 2005. We used interrupted time series (ITS) Poisson regression models to examine trends in monthly rates of ceftriaxone, ceftazidime, and cefepime use and trends in yearly rates of nonsusceptible isolates (NSIs) of select Gram-negative bacteria before (1998–2004) and after (2006–2016) fluoroquinolone preauthorization was implemented.

Results:

Rates of use of ceftriaxone and cefepime increased after fluoroquinolone preauthorization was implemented (ceftriaxone RR, 1.002; 95% CI, 1.002–1.003; P < .0001; cefepime RR, 1.003; 95% CI, 1.001–1.004; P = .0006), but ceftazidime use continued to decline (RR, 0.991, 95% CI, 0.990–0.992; P < .0001). Rates of ceftazidime and cefepime NSIs of Pseudomonas aeruginosa (ceftazidime RR, 0.937; 95% CI, 0.910–0.965, P < .0001; cefepime RR, 0.937; 95% CI, 0.912–0.963; P < .0001) declined after fluoroquinolone preauthorization was implemented. Rates of ceftazidime and cefepime NSIs of Enterobacter cloacae (ceftazidime RR, 1.116; 95% CI, 1.078–1.154; P < .0001; cefepime RR, 1.198; 95% CI, 1.112–1.291; P < .0001) and cefepime NSI of Acinetobacter baumannii (RR, 1.169; 95% CI, 1.081–1.263; P < .0001) were increasing before fluoroquinolone preauthorization was implemented but became stable thereafter: E. cloacae (ceftazidime RR, 0.987; 95% CI, 0.948–1.028; P = .531; cefepime RR, 0.990; 95% CI, 0.962–1.018; P = .461) and A. baumannii (cefepime RR, 0.972; 95% CI, 0.939–1.006; P = .100).

Conclusions:

Fluoroquinolone preauthorization may increase use of unrestricted third- and fourth-generation cephalosporins; however, we did not observe increased antimicrobial resistance to these agents, especially among clinically important Gram-negative bacteria known for hospital-acquired infections.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 7 , July 2022 , pp. 848 - 859
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Senior authors of equal contribution.

PREVIOUS PRESENTATION. Idigo AJ, Lee RA, Brown ML, etal. Impact of Fluoroquinolone Pre-authorization on Ceftriaxone Use and Resistance in a Large Academic Hospital in Southeast USA. Poster presentation at the 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management in Philadelphia, Pennsylvania, USA, on 08/28/19.

References

Davey, P, Marwick, CA, Scott, CL, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Revs 2017;2:CD003543.Google ScholarPubMed
Joint Commission on Hospital Accreditation. APPROVED: new antimicrobial stewardship standard. The Joint Commission website. Jt Comm Perspect 2016;36(7):1,3,4,8.Google Scholar
Baur, D, Gladstone, BP, Burkert, F, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis 2017;17:990–1001.CrossRefGoogle ScholarPubMed
Feazel, LM, Malhotra, A, Perencevich, EN, Kaboli, P, Diekema, DJ, Schweizer, ML. Effect of antibiotic stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis. J Antimicrobial Chemother 2014;69:1748–1754.10.1093/jac/dku046CrossRefGoogle ScholarPubMed
Lawes, T, Lopez-Lozano, JM, Nebot, CA, et al. Effect of a national 4C antibiotic stewardship intervention on the clinical and molecular epidemiology of Clostridium difficile infections in a region of Scotland: a nonlinear time-series analysis. Lancet Infect Dis 2017;17:194–206.10.1016/S1473-3099(16)30397-8CrossRefGoogle Scholar
Lee, RA, Scully, MC, Camins, BC, et al. Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a preauthorization policy for fluoroquinolone use: a decade-long experience. Infect Control Hosp Epidemiol 2018;39:1419–1424.10.1017/ice.2018.245CrossRefGoogle ScholarPubMed
Burke, JP. Antibiotic resistance—squeezing the balloon? JAMA 1998;280:1270–1271.CrossRefGoogle Scholar
Borde, JP, Kaier, K, Steib-Bauert, M, et al. Feasibility and impact of an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a tertiary care university medical center. BMC Infect Dis 2014;14:201.10.1186/1471-2334-14-201CrossRefGoogle Scholar
Determining patient days for summary data collection: observation vs. inpatients. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/PDFs/PatientDay_SumData_Guide.pdf. Accessed May 25, 2021.Google Scholar
Jones, RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 2010;51 suppl 1:S81–S87.10.1086/653053CrossRefGoogle Scholar
Paterson, DL. Resistance in gram-negative bacteria: Enterobacteriaceae. Am J Infect Control 2006;34(5 suppl 1):S20–S28.CrossRefGoogle ScholarPubMed
Humphries, RM, Ambler, J, Mitchell, SL, et al. CLSI methods development and standardization working group best practices for evaluation of antimicrobial susceptibility tests. J Clin Microbiol 2018;56(4):e01934–17.10.1128/JCM.01934-17CrossRefGoogle Scholar
Bassetti, M, Vena, A, Croxatto, A, Righi, E, Guery, B. How to manage Pseudomonas aeruginosa infections. Drugs Context 2018;7:212527.10.7573/dic.212527CrossRefGoogle ScholarPubMed
Kuhn, L, Davidson, LL, Durkin, MS. Use of Poisson regression and time series analysis for detecting changes over time in rates of child injury following a prevention program. Am J Epidemiol 1994;140:943–955.10.1093/oxfordjournals.aje.a117183CrossRefGoogle ScholarPubMed
Kreitmeyr, K, von Both, U, Pecar, A, Borde, JP, Mikolajczyk, R, Huebner, J. Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards. Infection 2017;45:493–504.CrossRefGoogle ScholarPubMed
Falagas, ME, Bliziotis, IA, Michalopoulos, A, et al. Effect of a policy for restriction of selected classes of antibiotics on antimicrobial drug cost and resistance. J Chemother (Florence, Italy) 2007;19:178–184.CrossRefGoogle ScholarPubMed
Schuts, EC, Boyd, A, Muller, AE, Mouton, JW, Prins, JM. The effect of antibiotic restriction programs on prevalence of antimicrobial resistance: a systematic review and meta-analysis. Open Forum Infect Dis 2021. doi: 10.1093/ofid/ofab070.CrossRefGoogle Scholar
Hilty, M, Betsch, BY, Bögli-Stuber, K, et al. Transmission dynamics of extended-spectrum β-lactamase–producing Enterobacteriaceae in the tertiary-care hospital and the household setting. Clin Infect Dis 2012;55:967–975.CrossRefGoogle ScholarPubMed
Doi, Y, Park, YS, Rivera, JI, et al. Community-associated extended-spectrum β-lactamase–producing Escherichia coli infection in the United States. Clin Infect Dis 2013;56:641–648.CrossRefGoogle ScholarPubMed
Sarma, JB, Marshall, B, Cleeve, V, Tate, D, Oswald, T, Woolfrey, S. Effects of fluoroquinolone restriction (from 2007 to 2012) on resistance in Enterobacteriaceae: interrupted time-series analysis. J Hosp Infect 2015;91:68–73.10.1016/j.jhin.2015.05.006CrossRefGoogle ScholarPubMed
Poole, K. Efflux-mediated resistance to fluoroquinolones in gram-negative bacteria. Antimicrob Agents Chemother 2000;44:2233–2241.CrossRefGoogle ScholarPubMed
Redgrave, LS, Sutton, SB, Webber, MA, Piddock, LJ. Fluoroquinolone resistance: mechanisms, impact on bacteria, and role in evolutionary success. Trends Microbiol 2014;22:438–445.10.1016/j.tim.2014.04.007CrossRefGoogle ScholarPubMed
Santajit, S, Indrawattana, N. Mechanisms of antimicrobial resistance in ESKAPE pathogens. Biomed Res Int 2016;2016:2475067. doi: 10.1155/2016/2475067.CrossRefGoogle ScholarPubMed
Robicsek, A, Strahilevitz, J, Jacoby, GA, et al. Fluoroquinolone-modifying enzyme: a new adaptation of a common aminoglycoside acetyltransferase. Nat Med 2006;12:83–88.10.1038/nm1347CrossRefGoogle ScholarPubMed
Nikaido, H. Prevention of drug access to bacterial targets: permeability barriers and active efflux. Science 1994;264:382–388.CrossRefGoogle ScholarPubMed
Morita, Y, Kodama, K, Shiota, S, et al. NorM, a putative multidrug efflux protein, of Vibrio parahaemolyticus and its homolog in Escherichia coli . Antimicrob Agents Chemother 1998;42:1778–1782.CrossRefGoogle ScholarPubMed
Robicsek, A, Jacoby, GA, Hooper, DC. The worldwide emergence of plasmid-mediated quinolone resistance. Lancet Infect Dis 2006;6:629–640.CrossRefGoogle ScholarPubMed
Jacoby, GA, Strahilevitz, J, Hooper, DC. Plasmid-mediated quinolone resistance. Microbiol Spectrum 2014;2(5). doi: 10.1128/microbiolspec.PLAS-0006-2013.CrossRefGoogle Scholar
Hooper, DC, Jacoby, GA. Mechanisms of drug resistance: quinolone resistance. Ann NY Acad Sci 2015;1354:12–31.CrossRefGoogle ScholarPubMed
van Schaik, W. The human gut resistome. Phil Trans Roy Soc London B Biol Sci 2015;370(1670):20140087.CrossRefGoogle ScholarPubMed
White, AC Jr, Atmar, RL, Wilson, J, Cate, TR, Stager, CE, Greenberg, SB. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230–239.10.1086/514545CrossRefGoogle ScholarPubMed
Humphries, RM, Abbott, AN, Hindler, JA. Understanding and addressing CLSI break point revisions: a primer for clinical laboratories. J Clin Microbiol 2019;57(6):e00203–19.CrossRefGoogle Scholar
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