Acceptability and effectiveness of antimicrobial stewardship implementation strategies on fluoroquinolone prescribing

Katie J. Suda*, Gosia S. Clore, Charlesnika T. Evans, Heather Schacht Reisinger, Ibuola Kale, Kelly Echevarria, Stacey Hockett Sherlock, Eli N. Perencevich, Matthew Bidwell Goetz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones. Methods: Stewardship champions at 15 hospitals were surveyed regarding the use and acceptability of strategies to improve fluoroquinolone prescribing. Antibiotic days of therapy (DOT) per 1,000 days present (DP) for sites with and without prospective audit and feedback (PAF) and/or prior approval were compared. Results: Among all of the sites, 60% had PAF or prior approval implemented for fluoroquinolones. Compared to sites using neither strategy (64.2 ± 34.4 DOT/DP), fluoroquinolone prescribing rates were lower for sites that employed PAF and/or prior approval (35.5 ± 9.8; P =.03) and decreased from 2017 to 2018 (P <.001). This decrease occurred without an increase in advanced-generation cephalosporins. Total antibiotic rates were 13% lower for sites with PAF and/or prior approval, but this difference did not reach statistical significance (P =.20). Sites reporting that PAF and/or prior approval were completely accepted had lower fluoroquinolone rates than sites where it was moderately accepted (34.2 ± 5.7 vs 48.7 ± 4.5; P <.01). Sites reported that clinical pathways and/or local guidelines (93%), prior approval (93%), and order forms (80%) would or may be effective in improving fluoroquinolone use. Although most sites (73%) indicated that requiring infectious disease consults would or may be effective in improving fluoroquinolones, 87% perceived implementation to be difficult. Conclusions: PAF and prior approval implementation strategies focused on fluoroquinolones were associated with significantly lower fluoroquinolone prescribing rates and nonsignificant decreases in total antibiotic use, suggesting limited evidence for class substitution. The association of acceptability of strategies with lower rates highlights the importance of culture. These results may indicate increased acceptability of implementation strategies and/or sensitivity to FDA warnings.

Original languageEnglish (US)
Pages (from-to)1361-1368
Number of pages8
JournalInfection Control and Hospital Epidemiology
Issue number11
StatePublished - Nov 12 2021

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases


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