JAC Advance Access published online on January 25, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm510
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Reducing empirical use of fluoroquinolones for Pseudomonas aeruginosa infections improves outcome
1 Loma Linda University, School of Pharmacy, Loma Linda, CA, USA 2 Western University, Pomona, CA, USA 3 University of Southern California, Los Angeles, CA, USA 4 Huntington Hospital, Pasadena, CA, USA
Received 10 August 2007; returned 4 December 2007; revised 11 October 2007; accepted 5 December 2007
* Correspondence address. University of Southern California, School of Pharmacy, 1985 Zonal Avenue, Los Angeles, CA 90033, USA. Tel: +1-323-442-1356; Fax: +1-626-628-3024; E-mail: anniew{at}usc.edu
Background: We previously reported ciprofloxacin resistance (CR) and empirical use of fluoroquinolones as predictors of mortality in patients infected with Pseudomonas aeruginosa in a case–control study. Here, we assessed the clinical impact of reducing empirical fluoroquinolone use for P. aeruginosa infections in hospitalized patients by performing a follow-up study in 2005–06 [period 2 (P2)] and comparing this with prior data from 2001–02 [period 1 (P1)].
Methods: Medical charts of infected patients who received at least 72 h of antibiotic therapy were reviewed. Patients were subgrouped based on the susceptibility of infected strains into the CR or ciprofloxacin-susceptible group. Antibiograms, patient and treatment variables and outcome measures were compared between groups and between study periods.
Results: Study patients were elderly (median age, 76 years), had a median of three co-morbidities and a median APACHE II score of 13. Most (75%) had pneumonia or urosepsis. Empirical use of fluoroquinolones was reduced by 30% in P2 versus P1, with a corresponding 39% increase in piperacillin/tazobactam use. The resultant positive impact observed in the CR group during P2 includes shortened delay to receipt of effective therapy (1 versus 3.5 days, P < 0.0001), reduced length of stay (13 versus 16 days, P = 0.03) and 2-fold lower mortality (9% versus 22%, P = 0.05). Susceptibility of P. aeruginosa improved by 10% to all antipseudomonal agents tested.
Conclusions: In settings where high rates of fluoroquinolone resistance exist, use of non-fluoroquinolone-based empirical regimens for P. aeruginosa infections improves patient outcomes and organism susceptibility over time.
Key Words: fluoroquinolone resistance , reduced mortality , prescribing changes