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Clin Infect Dis. 2019 Sep 28. pii: ciz967. doi: 10.1093/cid/ciz967. [Epub ahead of print]

Inpatient Fluoroquinolone Stewardship Improves the Quantity and Quality of Fluoroquinolone-prescribing at Hospital Discharge: A Retrospective Analysis among 122 Veterans Health Administration Hospitals.

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Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.



Despite increasing awareness of harms, fluoroquinolones are still frequently prescribed to inpatients and at hospital discharge. Our goal was to describe fluoroquinolone-prescribing at hospital discharge across the Veterans Health Administration (VHA) and to contrast fluoroquinolone-prescribing volume and appropriateness across 3 antimicrobial stewardship strategy-types.


We analyzed a retrospective cohort of patients hospitalized at 122 VHA acute-care hospitals during 2014-2016. Data from a mandatory VHA survey were used to identify 9 hospitals that self-reported one of 3 strategies for optimizing fluoroquinolone-prescribing: prospective audit-and-feedback (PAF), restrictive policies (RP), and no strategy. Manual chart reviews to assess fluoroquinolone appropriateness at hospital discharge (i.e. post-discharge) were performed across the 9 hospitals (3 hospitals and 125 cases per strategy-type).


There were 1.7 million patient-admissions. Overall, there were 1,727,478 fluoroquinolone days of therapy (DOTs) with 674,918 (39.1%) DOTs prescribed for inpatients and 1,052,560 (60.9%) DOTs received post-discharge. Among the 9 reviewed hospitals, post-discharge fluoroquinolone exposure was lower at hospitals using RP compared to no strategy (3.8% vs 9.3%, p=0.012). Post-discharge fluoroquinolones were deemed inappropriate in 154 of 375 (41.1%) patients. Fluoroquinolones were more likely to be inappropriate at hospitals without a strategy (52.8%) versus either RP or PAF (35.2%) (p=0.001).


In this retrospective cohort, the majority of fluoroquinolone DOTs occurred after hospital discharge. A large proportion of post-discharge fluoroquinolone prescriptions were inappropriate, especially in hospitals without a strategy to manage fluoroquinolone-prescribing. Our findings suggest that stewardship efforts to minimize and improve fluoroquinolone-prescribing should also focus on antibiotic-prescribing at hospital discharge.


Fluoroquinolone; antimicrobial stewardship; hospital discharge


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