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QUINOLONE RESTRICTION AT MARLBOROUGH HOSPITAL

QUINOLONE RESTRICTION AT MARLBOROUGH HOSPITAL. Vibha Sharma, M.D. Infectious disease consultant and Medical director, infection control, Marlborough hospital Zsusun Timothy Yang, Rph Pharmacy director Marlborough hospital. .

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QUINOLONE RESTRICTION AT MARLBOROUGH HOSPITAL

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  1. QUINOLONE RESTRICTION AT MARLBOROUGH HOSPITAL

  2. Vibha Sharma, M.D.Infectious disease consultant and Medical director, infection control,Marlborough hospitalZsusun Timothy Yang, RphPharmacy directorMarlborough hospital .

  3. Why the concern with QuinolonesFrom 2003 to 2006, C. difficile infections are observed to be more frequent, more severe, more refractory to standard therapy, and more likely to relapse than previously described .

  4. Some cases have been attributed to a new strain designated BI, NAP1 or ribotype 027. • Fluoroquinolone use has strongly correlated with the emergence of this strain. • Antibiotic use is the most widely recognized and modifiable risk factor for C. difficile-associated diarrhea (CDAD) • The use of broad-spectrum antimicrobials, use of multiple antibiotic agents, and increased duration of antibiotic therapy all contribute to the incidence of CDAD

  5. PREVIOUS USAGE OF QUINOLONES AT MARLBOROUGH HOSPITAL • Moxifloxacin formulary quinolone (FQ). No renal dosing (400 mg po/iv daily). Does not cover UTI. Ciprofloxacin reserved for these patients.

  6. QUINOLONE RESTRICTIONS • As of 12/1/10 FQ restriction to ID. • 24 hour supply allowed. • Pharmacy contacts via communication sheet/paging MD. • ID contacted via email. • Further supply restricted to ID approval.

  7. COMMUNICATION SHEET USED Communication Sheet From: Pharmacy To: Flouroquinolone restriction Dear doctor A flouroquinolone has been ordered for this patient. Due to the increasing rate of resistant bacteria and C. diff colitis, flouroquinolones are now restricted (exception-CAP with PCN allergy). This antibiotic will be discontinued in 24 hours from the time of the order. Continuation of flouroquinolones requires ID approval. (Dr. Sharma) Restricted antibiotic ordered: Pharmacist Signature: Response:Message: MD Signature:

  8. SENTRI 7 DATA FOR QUINOLONE USAGE

  9. SENTRI 7 QUINOLONE DATA • Only captures rule hits with Meditech profiling. • Does not capture ED 1 dose removals (ie overides).

  10. MEDITECH DATA FOR QUINOLONE USAGE Definitions • # RX- # of orders entered in Meditech system (1 patient with 1 renewal order and dosing/route changes can have 2 RX) • # Pts- # patients listed in reporting • # RX > 24 hours- RX with start and stop times > 24 hours entered From 12/10 on- checked individual patients with > 24 hours to validate if patient received > 1 day dosing. Assumption made that all patients prior to 12/10 had >24 hour therapy for #RX > 24 hours. ** All Quinolone data aggregated.

  11. MEDITECH DATA FOR QUINOLONE USAGE CONT.

  12. Actual patients receiving > 24 hr Quinolone therapy

  13. QUINOLONE TRENDS AUG 09 TO 2/11

  14. CHARACTERISTICS FOR PTS > 24 HRS USAGE (12/10- ) 1- 60 yo male with SIRS/Gastroenteritis 2- 39 yo female with PNA 3- 85 yo female with PNA (Documented PCN allergy) 4- 83 yo female with UTI (Documented PCN allergy) 5- 53 yo female with diverticulitis 6- 63 yo female with COPD- (PCN= hives) 7- 68 yo male with HA/SOB- dc home in 24 hours 8- 71 yo male COPD

  15. SENTRI 7 DATA FOR ABX USAGE

  16. MEDITECH REPORTING • Monthly analysis for August to March 1-16th for time frame of 8/09 to 3/16/11 • Antibiotics used for analysis: Ertapenum (E), Vancomycin (V), Ceftriaxone (CF), Levofloxacin, Ciprofloxacin, and Moxifloxacin • Levofloxacin, Ciprofloxacin, and Moxifloxacin data aggregated (FQ) • #RX and # PT collected.

  17. #RX ABX SPREAD • Quinolone most prescribed antibiotic in Feb 2010. • Ceftriaxone most prescirbed antibiotic overall during winter months.

  18. #PTS ABX DATA • Decline of patients on quinolones since December 2010. • Does not take account if patient switches antibiotic or has multiple drug therapy.

  19. % ABX orders comparing the four drugs • Ertapenum usage initially high, now consistent. • Ceftriaxone use increased with less usage of FQ and vice versa. • ? Increase use of Vancomycin after winter months.

  20. CONCLUSION • ONE TIME DOSES (OVERIDES, SDC PATIENTS) • SIGNIFICANT DROP OF TREATMENT OF QUINOLONES IN HOSPITAL INPATIENT FLOORS. • TIMELY COMMUNICATION ESSENTIAL • INITIAL SELECTION FOR CAP REMAINS 100%

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