{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T08:16:55Z","timestamp":1778055415702,"version":"3.51.4"},"reference-count":27,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2017,6,1]],"date-time":"2017-06-01T00:00:00Z","timestamp":1496275200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Fluoroquinolones are one of the most commonly prescribed antibiotic classes in the United States despite their association with adverse consequences, including\n            <jats:named-content content-type=\"genus-species\">Clostridium difficile<\/jats:named-content>\n            infection (CDI). We sought to evaluate the impact of a health care system antimicrobial stewardship-initiated respiratory fluoroquinolone restriction program on utilization, appropriateness of quinolone-based therapy based on institutional guidelines, and CDI rates. After implementation, respiratory fluoroquinolone utilization decreased from a monthly mean and standard deviation (SD) of 41.0 (SD = 4.4) days of therapy (DOT) per 1,000 patient days (PD) preintervention to 21.5 (SD = 6.4) DOT\/1,000 PD and 4.8 (SD = 3.6) DOT\/1,000 PD posteducation and postrestriction, respectively. Using segmented regression analysis, both education (14.5 DOT\/1,000 PD per month decrease;\n            <jats:italic>P<\/jats:italic>\n            = 0.023) and restriction (24.5 DOT\/1,000 PD per month decrease;\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.0001) were associated with decreased utilization. In addition, the CDI rates decreased significantly (\n            <jats:italic>P<\/jats:italic>\n            = 0.044) from preintervention using education (3.43 cases\/10,000 PD) and restriction (2.2 cases\/10,000 PD). Mean monthly CDI cases\/10,000 PD decreased from 4.0 (SD = 2.1) preintervention to 2.2 (SD = 1.35) postrestriction. A significant increase in appropriate respiratory fluoroquinolone use occurred postrestriction versus preintervention in patients administered at least one dose (74\/130 [57%] versus 74\/232 [32%];\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001), as well as in those receiving two or more doses (47\/65 [72%] versus 67\/191 [35%];\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001). A significant reduction in the annual acquisition cost of moxifloxacin, the formulary respiratory fluoroquinolone, was observed postrestriction compared to preintervention within the health care system ($123,882 versus $12,273;\n            <jats:italic>P<\/jats:italic>\n            = 0.002). Implementation of a stewardship-initiated respiratory fluoroquinolone restriction program can increase appropriate use while reducing overall utilization, acquisition cost, and CDI rates within a health care system.\n          <\/jats:p>","DOI":"10.1128\/aac.00125-17","type":"journal-article","created":{"date-parts":[[2017,3,28]],"date-time":"2017-03-28T00:40:52Z","timestamp":1490661652000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":36,"title":["Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection"],"prefix":"10.1128","volume":"61","author":[{"given":"Katherine M.","family":"Shea","sequence":"first","affiliation":[{"name":"Cardinal Health, Innovative Delivery Solutions, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athena L. V.","family":"Hobbs","sequence":"additional","affiliation":[{"name":"Baptist Memorial Hospital, Memphis, Tennessee, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa C.","family":"Jaso","sequence":"additional","affiliation":[{"name":"Seton Healthcare Family, Austin, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack D.","family":"Bissett","sequence":"additional","affiliation":[{"name":"Austin Infectious Diseases Consultants, Austin, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher M.","family":"Cruz","sequence":"additional","affiliation":[{"name":"University Medical Center Brackenridge, Austin, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth T.","family":"Douglass","sequence":"additional","affiliation":[{"name":"The University of Texas at Austin Dell Medical School, Austin, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin W.","family":"Garey","sequence":"additional","affiliation":[{"name":"University of Houston College of Pharmacy, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2004.09.015"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-187"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-015-0793-7"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2014.01.007"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1086\/430829"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-6701(98)90182-7"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid0906.020385"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt477"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.071812"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1086\/382690"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.03006-14"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2015.05.013"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1592\/phco.29.6.736"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-014-0693-2"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1310\/hpj4511-844"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dku498"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2007.02.028"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1086\/510393"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.7326\/M15-1840"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02039-13"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw118"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1086\/511789"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1086\/381551"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkl320"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1605.071606"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa051590"},{"key":"e_1_3_2_28_2","volume-title":"CDC\/NHSN surveillance definitions for specific types of infections","author":"Centers for Disease Control and Prevention (CDC)\/National Healthcare Safety Network","year":"2016","unstructured":"Centers for Disease Control and Prevention (CDC)\/National Healthcare Safety Network. 2016. CDC\/NHSN surveillance definitions for specific types of infections. Centers for Disease Control and Prevention, Atlanta, GA. http:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/17pscnosinfdef_current.pdf."}],"container-title":["Antimicrobial Agents and Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/AAC.00125-17","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/AAC.00125-17","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T20:37:42Z","timestamp":1645475862000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/AAC.00125-17"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6]]},"references-count":27,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2017,6]]}},"alternative-id":["10.1128\/AAC.00125-17"],"URL":"https:\/\/doi.org\/10.1128\/aac.00125-17","relation":{},"ISSN":["0066-4804","1098-6596"],"issn-type":[{"value":"0066-4804","type":"print"},{"value":"1098-6596","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6]]},"assertion":[{"value":"2017-01-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-03-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-05-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00125-17"}}