Resistance to ciprofloxacin has markedly increased over the past several years as a result of increased prescribing. It is not an appropriate first line agent for infections caused by highly susceptible organisms. Additionally, this agent is strongly associated with C.difficile infections.
The objective of this study was to determine the impact of eliminating ciprofloxacin, for certain highly susceptible bacteria, from the electronic medical record, which prescribers use to select agents to treat various infections. This process is known as selective reporting. This project was implemented as part of an antimicrobial stewardship program in a hospital setting. Our antimicrobial stewardship program is multi-faceted including prospective audit and feedback, education as well as guidelines and order sets.
A key objective of this program was to reduce broad-spectrum or “high-risk” (e.g., ciprofloxacin) antimicrobial utilization. Historically, the microbiology laboratory practice was to report ciprofloxacin susceptibility for all Enterobacteriaceae regardless of susceptibility to other agents. A selective reporting policy was created and implemented by the antimicrobial stewardship program in collaboration with the microbiology laboratory in February 2011. The policy involved the suppression (i.e., non-reporting) of ciprofloxacin susceptibility to Enterobacteriaceae when there was lack of resistance to the antibiotics on the gram negative panel.
Ciprofloxacin utilization (measured by Defined Daily Doses (DDD)/1000 patient days) 34 months before and 38 months after the intervention (policy implementation) was collected. A pre and post- analysis was performed. Pre-intervention (April 2008-Janurary 2011), ciprofloxacin utilization was 87.9 DDD/1000 patient days. Following the intervention (February 2011 to January 2014), ciprofloxacin utilization decreased to 45.2 DDD/1000 patient days. This represents an approximate 50% decrease (p<0.0001) in ciprofloxacin utilization after selective ciprofloxacin susceptibility reporting.
Although selective reporting is not a new concept, this is the first assessment to look specifically at fluoroquinolone selective reporting and its impact as part of an antimicrobial stewardship program on overall utilization. Previous studies have demonstrated an impact on influencing prescribers’ decision making on an individual patient basis. However, this study was able to assess the impact on utilization of this drug across the institution. It is a simple rule-based approach to reducing unnecessarily broad spectrum antimicrobial utilization when prescribing medications through the electronic medical record.
Title: Lead Pharmacist, Antimicrobial Stewardship Program
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