Study finds peer comparison helps reduce fluoroquinolone use
A new study in the Journal of the American College of Clinical Pharmacy shows that the use of peer comparison reports based on prescriber specialty was tied to less use of fluoroquinolone antibiotics throughout a large community-hospital system.
In the quasi-experimental study, which was conducted at 16 community hospitals in Florida in 2017, researchers evaluated the impact of 1,265 peer comparison reports issued to high-volume prescribers in three different medical specialty cohorts: internal medicine/hospitalists/family medicine, intensivists/pulmonologists, and infectious diseases. The reports provided feedback to each eligible prescriber on their prescribing patterns and compared them to others within their peer group.
The primary study outcome was fluoroquinolone days of therapy (DOT) per 1,000 patient-days (PD) in the intervention period compared with the baseline period. Additional outcomes included total antibiotic days of therapy, total percentage of antibiotic days attributable to fluoroquinolones, and cases of hospital-acquired Clostridioides difficile/1,000 PD.
During the intervention period, fluoroquinolone use declined 29% compared with the baseline period, from 83.9 DOT/1,000 PD to 58.3 DOT/1,000 PD. Declines were observed in all facilities included in the study, but fluoroquinolone use decreased most among the facilities with the highest baseline use. The percentage of antibiotic days attributable to fluoroquinolones fell from 15.4% in the baseline period to 11.3% in the intervention period. In addition, total antibiotic days of therapy fell by 6%, and use of other key antibiotic classes, including third-generation cephalosporins and anti-pseudomonal beta-lactams, remained unchanged. The rate of hospital-acquired C difficile fell by 20%.
The authors of the study say their findings are consistent with most of the previous studies that demonstrate that behavioral interventions can have a positive impact on antibiotic prescribing, and they conclude that providing prescribers with feedback on antibiotic use may be a useful behavior modification tool for inpatient stewardship programs.
Mar 23 J Am Coll Clin Pharm abstract
Antipseudomonal combo therapy for pneumonia linked to higher mortality
A study last week by researchers with the University of Texas and the University of Connecticut has found that older adults who received antipseudomonal combination therapy (PCT) for community-onset pneumonia had worse outcomes than those who received antipseudomonal monotherapy (PMT).
The population-based, retrospective cohort study, published in the American Journal of Infection Control, used data from more than 150 hospitals and 1,400 clinics in the Veterans Health Administration (VHA) system. The researchers used VHA electronic medical records to categorize pneumonia patients as having low, medium, or high risk of drug-resistant pathogens and to assign them to PCT or PMT treatment arms based on antibiotics received in the first 48 hours of hospital admission. They then compared all-cause 30-day mortality in the two groups.
Of the 31,027 patients who met the criteria for the study, 23% received PCT and 77% received PMT. The unadjusted mortality difference between PCT and PMT was most pronounced in the low-risk group (18% vs 8%), followed by the medium-risk group (24% vs 18%) and the high-risk group (39% vs 33%). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.43 to 1.66) and in all three risk groups: low (aOR, 1.69; 95% CI, 1.50 to 1.89), medium (aOR, 1.30; 95% CI, 1.14 to 1.48), and high (aOR, 1.21; 95% CI, 1.04 to 1.40)
The findings are important, because community-acquired pneumonia guidelines from both the American Thoracic Society and the Infectious Diseases Society of America recommend PCT when Pseudomonas pneumonia is suspected. The authors of the study say that the data from this study, and their previous study of empiric Pseudomonas therapy in patients with community-acquired pneumonia, indicate that the guidelines should be changed.
"We support the use of empiric PMT in high-risk patients, but we do not support the use of empiric PCT in pneumonia patients from any of the risk groups," they write. "PCT may be beneficial over PMT for patients with known Pseudomonas (ie, definitive therapy)—a question beyond the scope of this study—but PCT is not associated with additional benefit in patients simply suspected of having Pseudomonas (ie, empiric therapy)."
Mar 21 Am J Infect Control study