Impact of Intervention by an Antimicrobial Stewardship Team on Conversion from Intravenous to Oral Fluoroquinolones
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Background: Early conversion from intravenous to oral antibiotics plays an important role in lowering the risk of catheter-associatedinfections, reducing the workload of nurses, decreasing direct and indirect costs, and shortening hospital stays. In August2015, an antimicrobial stewardship program (ASP) was implemented to facilitate conversion from intravenous to oral administrationof fluoroquinolones in our institute. This study evaluated the clinical and economic impact of the intervention. Materials and Methods: Data were retrospectively collected by reviewing electronic medical records. All hospitalized patientsaged 18 and older who met the study inclusion criteria for the conversion were included between August and November 2015. We computed the physicians’ adherence rate to the ASP recommendations. We also measured the total use of fluoroquinolones,length of hospital stay, and medication costs. Results: During 4 months, 129 cases were enrolled in the study. The adherence rate was 79.8%. The average total prescriptionvolume of intravenous fluoroquinolones, the length of hospital stay, and the total cost of the fluoroquinolones statistically significantlydecreased in the intervention-adherent group. Conclusion: Intervention to facilitate conversion from intravenous to oral administration has reduced excess use of intravenousfluoroquinolones and length of hospital stay. With these findings, further implementations of the ASP extending to other antibioticsmay be warranted.
Abstract
Background: Early conversion from intravenous to oral antibiotics plays an important role in lowering the risk of catheter-associatedinfections, reducing the workload of nurses, decreasing direct and indirect costs, and shortening hospital stays. In August2015, an antimicrobial stewardship program (ASP) was implemented to facilitate conversion from intravenous to oral administrationof fluoroquinolones in our institute. This study evaluated the clinical and economic impact of the intervention. Materials and Methods: Data were retrospectively collected by reviewing electronic medical records. All hospitalized patientsaged 18 and older who met the study inclusion criteria for the conversion were included between August and November 2015. We computed the physicians’ adherence rate to the ASP recommendations. We also measured the total use of fluoroquinolones,length of hospital stay, and medication costs. Results: During 4 months, 129 cases were enrolled in the study. The adherence rate was 79.8%. The average total prescriptionvolume of intravenous fluoroquinolones, the length of hospital stay, and the total cost of the fluoroquinolones statistically significantlydecreased in the intervention-adherent group. Conclusion: Intervention to facilitate conversion from intravenous to oral administration has reduced excess use of intravenousfluoroquinolones and length of hospital stay. With these findings, further implementations of the ASP extending to other antibioticsmay be warranted.
참고문헌 (18)
- Hecker MT, "Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity", Arch Intern Med, 163, pp.972~978 (2003)
- Werner NL, "Unnecessary use of fluoroquinolone antibiotics in hospitalized patients", BMC Infect Dis, 11, pp.187~ (2011)
- Dellit TH, "Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship", Clin Infect Dis, 44, pp.159~177 (2007)
- 송영주, "Impact of an Antimicrobial Stewardship Program on Unnecessary Double Anaerobic Coverage Prescription", Infection and Chemotherapy, 47(2), pp.111~116 (2015), 대한감염학회[DOI]
- Rodvold KA, "Pharmacokinetics and pharmacodynamics of fluoroquinolones", Pharmacotherapy, 21(10 Pt 2), pp.233S~252S (2001)
- Ho BP, "The impact of a pharmacist-managed dosage form conversion service on ciprofloxacin usage at a major Canadian teaching hospital: a pre-and post-intervention study", BMC Health Serv Res, 5, pp.48~ (2005)
- Yen YH, "Clinical and economic impact of a pharmacist-managed i.v.-to-p.o. conversion service for levofloxacin in Taiwan", Int J Clin Pharmacol Ther, 50, pp.136~141 (2012)
- Knaus WA, "APACHE II: a severity of disease classification system", Crit Care Med, 13, pp.818~829 (1985)
- Charlson M, "Validation of a combined comorbidity index", J Clin Epidemiol, 47, pp.1245~1251 (1994)
- Linder JA, "Fluoroquinolone prescribing in the United States: 1995 to 2002", Am J Med, 118, pp.259~268 (2005)
- Shrayteh ZM, "Practice of switch from intravenous to oral antibiotics", Springerplus, 3, pp.717~ (2014)
- Sevinç F, "Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital", J Antimicrob Chemother, 43, pp.601~606 (1999)
- Schouten JA, "Tailored interventions to improve antibiotic use for lower respiratory tract infections in hospitals: a cluster-randomized, controlled trial", Clin Infect Dis, 44, pp.931~941 (2007)
- Engel MF, "Barriers to an early switch from intravenous to oral antibiotic therapy in hospitalised patients with CAP", Eur Respir J, 41, pp.123~130 (2013)
- Fischer MA, "Conversion from intravenous to oral medications: assessment of a computerized intervention for hospitalized patients", Arch Intern Med, 163, pp.2585~2589 (2003)
- Hulgan T, "Oral quinolones in hospitalized patients: an evaluation of a computerized decision support intervention", J Intern Med, 256, pp.349~357 (2004)
- Davis SL, "Pharmacoeconomic considerations associated with the use of intravenous- to-oral moxifloxacin for community-acquired pneumonia", Clin Infect Dis, 41(Suppl 2), pp.S136~S143 (2005)
- MacGregor RR, "Oral administration of antibiotics: a rational alternative to the parenteral route", Clin Infect Dis, 24, pp.457~467 (1997)