{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T15:27:20Z","timestamp":1773415640304,"version":"3.50.1"},"reference-count":25,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2017,1,5]],"date-time":"2017-01-05T00:00:00Z","timestamp":1483574400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec id=\"S0899823X16003159_abs1\" sec-type=\"objectives\"><jats:title>OBJECTIVES<\/jats:title><jats:p>To evaluate changes in outpatient fluoroquinolone (FQ) and nitrofurantoin (NFT) use and resistance among <jats:italic>E. coli<\/jats:italic> isolates after a change in institutional guidance to use NFT over FQs for acute uncomplicated cystitis.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16003159_abs2\" sec-type=\"general\"><jats:title>DESIGN<\/jats:title><jats:p>Retrospective preintervention\u2013postintervention study.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16003159_abs3\" sec-type=\"general\"><jats:title>SETTING<\/jats:title><jats:p>Urban, integrated healthcare system.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16003159_abs4\" sec-type=\"general\"><jats:title>PATIENTS<\/jats:title><jats:p>Adult outpatients treated for acute cystitis.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16003159_abs5\" sec-type=\"methods\"><jats:title>METHODS<\/jats:title><jats:p>We compared 2 time periods: January 2003\u2013June 2007 when FQs were recommended as first-line therapy, and July 2007\u2013December 2012, when NFT was recommended. The main outcomes were changes in FQ and NFT use and FQ- and NFT-resistant <jats:italic>E. coli<\/jats:italic> by time-series analysis.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16003159_abs6\" sec-type=\"results\"><jats:title>RESULTS<\/jats:title><jats:p>Overall, 5,714 adults treated for acute cystitis and 11,367 outpatient <jats:italic>E. coli<\/jats:italic> isolates were included in the analysis. After the change in prescribing guidance, there was an immediate 26% (95% CI, 20%\u201332%) decrease in FQ use (<jats:italic>P<\/jats:italic>&lt;.001), and a nonsignificant 6% (95% CI, \u22122% to 15%) increase in NFT use (<jats:italic>P<\/jats:italic>=.12); these changes were sustained over the postintervention period. Oral cephalosporin use also increased during the postintervention period. There was a significant decrease in FQ-resistant <jats:italic>E. coli<\/jats:italic> of \u22120.4% per quarter (95% CI, \u22120.6% to \u22120.1%; <jats:italic>P<\/jats:italic>=.004) between the pre- and postintervention periods; however, a change in the trend of NFT-resistant <jats:italic>E. coli<\/jats:italic> was not observed.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16003159_abs7\" sec-type=\"conclusions\"><jats:title>CONCLUSIONS<\/jats:title><jats:p>In an integrated healthcare system, a change in institutional guidance for acute uncomplicated cystitis was associated with a reduction in FQ use, which may have contributed to a stabilization in FQ-resistant <jats:italic>E. coli<\/jats:italic>. Increased nitrofurantoin use was not associated with a change in NFT resistance.<\/jats:p><jats:p><jats:italic>Infect Control Hosp Epidemiol<\/jats:italic> 2017;38:461\u2013468<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2016.315","type":"journal-article","created":{"date-parts":[[2017,1,5]],"date-time":"2017-01-05T02:39:53Z","timestamp":1483583993000},"page":"461-468","source":"Crossref","is-referenced-by-count":15,"title":["Preferential Use of Nitrofurantoin Over Fluoroquinolones for Acute Uncomplicated Cystitis and Outpatient <i>Escherichia coli<\/i> Resistance in an Integrated Healthcare System"],"prefix":"10.1017","volume":"38","author":[{"given":"Rebecca L.","family":"Pedela","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine C.","family":"Shihadeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan C.","family":"Knepper","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle K.","family":"Haas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William J.","family":"Burman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy C.","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2017,1,5]]},"reference":[{"key":"S0899823X16003159_ref14","unstructured":"FDA Drug Safety Communication. 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