Stewardship bundle ‘dramatically’ decreases fluoroquinolone use in UTIs
An antimicrobial stewardship bundle implemented at nearly two dozen urgent and primary care clinics in Florida resulted in a dramatic decrease in fluoroquinolone use for UTIs, researchers reported.
“This project was prompted by the recognition of need for antimicrobial stewardship in the outpatient setting within our health system,” Ashley L. Cubillos, PharmD, a clinical infectious diseases pharmacist at Lee Health in Fort Myers, Florida, told Healio.
“It was noted that our urgent care and primary care clinic locations had opportunities to decrease their utilization of fluoroquinolone antibiotics for uncomplicated infections in outpatients,” Cubillos said. “Thus, we implemented order sets and UTIs that directed prescribers to preferred alternative antibiotic therapy choices and provided prescriber-level (or clinic-level) feedback on fluoroquinolone prescribing.”
In 2019, Cubillos and colleagues launched an antimicrobial stewardship intervention bundle to decrease fluoroquinolone use for UTIs at four urgent care clinics and 19 primary care clinics associated with Lee Health.
The bundle included the development of an antimicrobial stewardship team, a treatment pathway that emphasized antibiotics other than fluoroquinolones for uncomplicated UTIs, an educational presentation for providers, and a process to track and review their habits in prescribing fluoroquinolones.
For the study, Cubillos and colleagues compared prescribing data from a 6-month postintervention period — September 2019 to February 2020 — with data from a preintervention period running from September 2018 to February 2019. They also compared a third period dating from September 2020 to February 2021 during which prescribing data feedback was not provided with the preintervention period.
Cubillos said fluoroquinolone prescribing for UTI-related visits at the 23 locations “decreased dramatically.”
According to the study, among the four urgent care clinics, 3% of 3,752 UTI visits in the postintervention period resulted in a fluoroquinolone prescription compared with 17.6% of 3,741 in the preintervention period — a decrease of 14.6 percentage points (P < .001) and a net reduction in fluoroquinolone prescriptions of 83%.
The researchers observed similar findings among the 19 primary care clinics, with 6.8% of 2,287 UTI visits in the postintervention period resulting in a fluoroquinolone prescription vs. 23.8% of 2,071 in the preintervention period (P < .001), a net decrease of 71.3%.
There was also a sustained decrease in the percentage of fluoroquinolones prescribed for UTIs in the third assessment period compared with the preintervention period for both urgent care (3%; P < .0001) and primary care (7%; P < .0001).
“Attention to antimicrobial stewardship initiatives in the outpatient setting is increasing nationally, and increasingly, health systems are on the lookout for initiatives that are applicable, effective, and feasible in these care settings,” Cubillos said. “Our experience shows the value of a coordinated bundle that includes prescribing data feedback for optimizing antibiotic prescribing practice in a community health system.”