{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:19:13Z","timestamp":1790900353856,"version":"4.1.0"},"reference-count":31,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2018,10,9]],"date-time":"2018-10-09T00:00:00Z","timestamp":1539043200000},"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":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X18002453_abs1\" sec-type=\"general\"><jats:title>Objective<\/jats:title><jats:p>Due to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18002453_abs2\" sec-type=\"general\"><jats:title>Design<\/jats:title><jats:p>Retrospective cohort.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18002453_abs3\" sec-type=\"general\"><jats:title>Setting<\/jats:title><jats:p>Large academic medical center.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18002453_abs4\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: <jats:italic>Acinetobacter<\/jats:italic> spp., <jats:italic>Enterobacter cloacae<\/jats:italic>, <jats:italic>Escherichia coli<\/jats:italic>, <jats:italic>Klebsiella pneumoniae<\/jats:italic>, and <jats:italic>Pseudomonas aeruginosa.<\/jats:italic> Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998\u20132005) and the postimplementation period (2006\u20132016).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18002453_abs5\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Large rates of decline of FQ susceptibility began in 1998, particularly among <jats:italic>P. aeruginosa, Acinetobacter<\/jats:italic> spp., and <jats:italic>E. cloacae<\/jats:italic>. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to &lt;60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for <jats:italic>Acinetobacter<\/jats:italic> spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005\u20131.072), <jats:italic>E. cloacae<\/jats:italic> (RR, 1.028; 95% CI, 1.013\u20131.044), and <jats:italic>P. aeruginosa<\/jats:italic> (RR, 1.013; 95% CI, 1.006\u20131.020). No significant change in susceptibility was detected for <jats:italic>K. pneumoniae<\/jats:italic> (RR, 1.002; 95% CI, 0.996\u20131.008), and the susceptibility for <jats:italic>E. coli<\/jats:italic> continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975\u20130.987).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18002453_abs6\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>A stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except <jats:italic>E. coli<\/jats:italic>. For 3 species (ie, <jats:italic>Acinetobacter<\/jats:italic> spp<jats:italic>, E. cloacae<\/jats:italic>, and <jats:italic>P. aeruginosa<\/jats:italic>), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2018.245","type":"journal-article","created":{"date-parts":[[2018,10,9]],"date-time":"2018-10-09T04:35:38Z","timestamp":1539059738000},"page":"1419-1424","source":"Crossref","is-referenced-by-count":13,"title":["Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a pre-authorization policy for fluoroquinolone use: A decade-long experience"],"prefix":"10.1017","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9701-8156","authenticated-orcid":false,"given":"Rachael A.","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan C.","family":"Scully","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard C.","family":"Camins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell L.","family":"Griffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle F.","family":"Kunz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A.","family":"Moser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig J.","family":"Hoesley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd P.","family":"McCarty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Pappas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2018,10,9]]},"reference":[{"key":"S0899823X18002453_ref6","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkn514"},{"key":"S0899823X18002453_ref27","doi-asserted-by":"publisher","DOI":"10.1086\/589813"},{"key":"S0899823X18002453_ref30","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.45.3.883-892.2001"},{"key":"S0899823X18002453_ref21","doi-asserted-by":"publisher","DOI":"10.1592\/phco.29.6.736"},{"key":"S0899823X18002453_ref4","doi-asserted-by":"publisher","DOI":"10.3201\/eid0901.020277"},{"key":"S0899823X18002453_ref9","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.877"},{"key":"S0899823X18002453_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkq351"},{"key":"S0899823X18002453_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkq525"},{"key":"S0899823X18002453_ref12","doi-asserted-by":"publisher","DOI":"10.1086\/658946"},{"key":"S0899823X18002453_ref8","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1007\/s10096-003-0975-6","article-title":"Incidence and risk factors for nosocomial infections caused by fluoroquinolone-resistant Escherichia coli","volume":"22","author":"Huotari","year":"2003","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"S0899823X18002453_ref2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-016-2091-0"},{"key":"S0899823X18002453_ref31","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1093\/ajhp\/60.19.1962","article-title":"Effect of fluoroquinolone expenditures on susceptibility of Pseudomonas aeruginosa to ciprofloxacin in US hospitals","volume":"60","author":"Bhavnani","year":"2003","journal-title":"Am J Health-Syst Pharm"},{"key":"S0899823X18002453_ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s11845-016-1538-z"},{"key":"S0899823X18002453_ref7","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.39.2.520"},{"key":"S0899823X18002453_ref26","doi-asserted-by":"publisher","DOI":"10.1086\/514545"},{"key":"S0899823X18002453_ref17","doi-asserted-by":"publisher","DOI":"10.1089\/107662902760326959"},{"key":"S0899823X18002453_ref23","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1590"},{"key":"S0899823X18002453_ref3","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02505-15"},{"key":"S0899823X18002453_ref15","doi-asserted-by":"publisher","DOI":"10.1086\/432056"},{"key":"S0899823X18002453_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2015.05.006"},{"key":"S0899823X18002453_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2004.09.015"},{"key":"S0899823X18002453_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2014.12.010"},{"key":"S0899823X18002453_ref29","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2015.239"},{"key":"S0899823X18002453_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmii.2011.12.019"},{"key":"S0899823X18002453_ref5","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.162.21.2469"},{"key":"S0899823X18002453_ref22","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkw055"},{"key":"S0899823X18002453_ref11","doi-asserted-by":"publisher","DOI":"10.1086\/605924"},{"key":"S0899823X18002453_ref25","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00950-16"},{"key":"S0899823X18002453_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt212"},{"key":"S0899823X18002453_ref28","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/976273"},{"key":"S0899823X18002453_ref10","doi-asserted-by":"publisher","DOI":"10.1086\/322667"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X18002453","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T18:38:00Z","timestamp":1555094280000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X18002453\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,9]]},"references-count":31,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2018,12]]}},"alternative-id":["S0899823X18002453"],"URL":"https:\/\/doi.org\/10.1017\/ice.2018.245","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,9]]}}}