Background: Between 2007 and 2015, inpatient fluoroquinolone use declined in U.S. Veterans Affairs (VA) hospitals. Whether fluoroquinolone use at discharge has 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 560,219 hospitalizations meeting inclusion criteria as hospitalizations with infection (Table 1), 37.4% (209,602/560,219) had a fluoroquinolone prescribed either during hospitalization (32.5% [182 337/560 219]) or at discharge (19.6% [110 003/560 219]). Hospitals varied appreciably in inpatient, discharge, and total fluoroquinolone use, with 71% of hospitals in the highest prescribing quartile located in the southern U.S. Nearly all measures of fluoroquinolone use decreased between 2014 and 2017, with the largest decreases found in inpatient fluoroquinolone and ciprofloxacin use (Figure 1). In contrast, there was minimal decline in fluoroquinolone use at discharge (Figure 21), which accounted for 61.3% (1433/2339) of hospitalization-related fluoroquinolone days by 2017.
Conclusions: Between 2014 and 2017, fluoroquinolone use decreased in VA hospitals, largely driven by a decrease in inpatient fluoroquinolone (especially ciprofloxacin) use. Fluoroquinolone prescribing at discharge, and levofloxacin prescribing overall, remain prime targets for stewardship.
