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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3101 — Parenteral to Oral Conversion of Fluoroquinolones: Low-Hanging Fruit for Antimicrobial Stewardship Programs?

Huttner BJones MM, VA Salt Lake City Healthcare System IDEAS Center; Madaras-Kelly K, Boise VA Medical Center; Nechodom K, VA Salt Lake City Healthcare System IDEAS Center; Nielson C, VA Sierra Nevada HCS; Goetz MB, VA Greater LA Healthcare System; Neuhauser M, Department of Veterans Affairs Pharmacy Benefit Management Strategic Healthcare Group; Samore MH, and Rubin M, VA Salt Lake City Healthcare System IDEAS Center;

Objectives:
Early parenteral to gastroenteric conversion of antibiotics is a safe and straightforward antibiotic stewardship intervention. As VA seeks to develop antibiotic stewardship programs, we sought to characterize current practice by estimating avoidable intravenous (IV) fluoroquinolone use in VA hospitals.

Methods:
We performed a retrospective analysis of bar code medication administration (BCMA) data in acute-care wards of 128 VA hospitals throughout the entire United States. Data for all medications administered between January 1, 2006, and December 31, 2010 on acute-care wards, were analyzed. Patient days on therapy were expressed as fluoroquinolone days (FD) and divided into intravenous (IV; all doses given IV) and oral (PO; at least one dose given per os) FD. We assumed IV fluoroquinolone use to be potentially avoidable on a given day when there was at least one other medication administered via the enteral route on an IV FD.

Results:
Over the entire study period, 884,740 IV and 830,572 PO FD were administered. Overall, avoidable IV fluoroquinolone use accounted for 46.8% of all FD and for 90.9% of IV FD. Removing the first 2 days of all IV fluoroquinolone courses and limiting the analysis to the non-ICU setting yielded more conservative estimates of avoidable IV use: 20.9% of all FD and 45.9% of IV FD. Avoidable IV use was more common for levofloxacin (65.3% levofloxacin FD) and more frequent in the ICU setting (65.0%). There was a moderate correlation between avoidable IV FD and total systemic antibiotic use (r = 0.32).

Implications:
Avoidable IV fluoroquinolone use seems to be common in the VA system but important variations exist between facilities. The higher percentage of IV levofloxacin use may be a manifestation of formulary restriction of PO levofloxacin. The correlation between avoidable IV FD and total systemic antibiotic use is consistent with the hypothesis that local practice patterns may be driving both.

Impacts:
Antibiotic stewardship programs could focus on this patient safety issue as a “low-hanging fruit” to increase awareness of appropriate antibiotic use.


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