70 - Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis

Background: Fluoroquinolones (FQ) are associated with multiple adverse effects and increasing resistance. Acute uncomplicated cystitis (AUC) treatment remains a frequent reason for FQ use. Previous data suggests that suppression of FQ susceptibility results can decrease inpatient use, but may not reduce prescribing at discharge. The purpose of this study was to investigate the impact of FQ susceptibility suppression on discharge prescribing for AUC.

Methods: This was a retrospective, quasi-experimental study in adult patients at a 350-bed academic medical center. The effect of suppression of FQ susceptibilities on pan-susceptible urine isolates for Klebsiella sp. and E. coli on FQ prescribing and appropriateness at discharge was compared one year before and after the intervention, starting in March 2018. Risk factors for FQ use were also examined. Exclusion criteria included pyelonephritis, urinary hardware, pregnancy, concomitant infections treated with FQ, and organisms not susceptible to FQ. Risk ratios of FQ use were calculated for pre-/post-groups and stratified by discharging team for adjusted rates (aRR) using a Cochran-Mantel-Haenszel approach. For secondary outcomes, Chi-Square statistics and generalized regression models were used to assess odds of FQ use among variables.

Results: Overall discharge FQ prescribing decreased from 41.1% to 21.1% after the intervention, corresponding to a 53% lower adjusted risk (aRR 0.47 [95% CI 0.28-0.81]). One-hundred percent of FQ use was inappropriate, largely due to organism susceptibility to a guideline-preferred agent (n = 33/38). After adjusting for the intervention and clustering of discharge team, the odds of outpatient FQ use was 3.46 times higher for uninsured vs. insured patients, and 13.4 times higher among those who received FQ while inpatient.FQ Use at Discharge
Other Antibiotic Use
Risk Factors for FQ Use at Discharge


Conclusion: Suppression of FQ susceptibilities on pan-susceptible urine isolates for Klebsiella sp. and E. coli was associated with a decrease in FQ prescribing at discharge for AUC. Patients who received FQ while inpatient were 13.4 times more likely to be continued on FQ at discharge. Overall, prescribing of FQ for AUC was inappropriate, and stewardship programs should implement FQ suppression policies to improve FQ prescribing at discharge.