Inpatient and Discharge Fluoroquinolone Prescribing in Veterans Affairs Hospitals Between 2014 and 2017

Valerie M Vaughn; Sarah M Seelye; Xiao Qing Wang; Wyndy L Wiitala; Michael A Rubin; Hallie C Prescott

doi:10.1093/ofid/ofaa149

Inpatient and Discharge Fluoroquinolone Prescribing in Veterans Affairs Hospitals Between 2014 and 2017

Open Forum Infect Dis. 2020 Apr 30;7(5):ofaa149. doi: 10.1093/ofid/ofaa149. eCollection 2020 May.

Authors

Valerie M Vaughn^{1

2}, Sarah M Seelye¹, Xiao Qing Wang^{1

3}, Wyndy L Wiitala¹, Michael A Rubin^{4

5}, Hallie C Prescott^{1

3}

Affiliations

¹ Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
² Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
⁴ VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
⁵ University of Utah School of Medicine, Salt Lake City, Utah, USA.

Abstract

Background: Between 2007 and 2015, inpatient fluoroquinolone use declined in US Veterans Affairs (VA) hospitals. Whether fluoroquinolone use at discharge also declined, in particular since antibiotic stewardship programs became mandated at VA hospitals in 2014, is unknown.

Methods: In this retrospective cohort study of hospitalizations with infection between January 1, 2014, and December 31, 2017, at 125 VA hospitals, we assessed inpatient and discharge fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin) use as (a) proportion of hospitalizations with a fluoroquinolone prescribed and (b) fluoroquinolone-days per 1000 hospitalizations. After adjusting for illness severity, comorbidities, and age, we used multilevel logit and negative binomial models to assess for hospital-level variation and longitudinal prescribing trends.

Results: Of 560219 hospitalizations meeting inclusion criteria as hospitalizations with infection, 37.4% (209602/560219) had a fluoroquinolone prescribed either during hospitalization (32.5%, 182337/560219) or at discharge (19.6%, 110003/560219). Hospitals varied appreciably in inpatient, discharge, and total fluoroquinolone use, with 71% of hospitals in the highest prescribing quartile located in the Southern United States. Nearly all measures of fluoroquinolone use decreased between 2014 and 2017, with the largest decreases found in inpatient fluoroquinolone and ciprofloxacin use. In contrast, there was minimal decline in fluoroquinolone use at discharge, which accounted for a growing percentage of hospitalization-related fluoroquinolone-days (52.0% in 2014; 61.3% by 2017).

Conclusions: Between 2014 and 2017, fluoroquinolone use decreased in VA hospitals, largely driven by decreased inpatient fluoroquinolone (especially ciprofloxacin) use. Fluoroquinolone prescribing at discharge, as well as levofloxacin prescribing overall, is a growing target for stewardship.

Keywords: antibiotic stewardship; fluoroquinolones; infection; transitions of care; veterans.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2020.