Background: Overuse of fluoroquinolones has led to concerning rates of resistance, particularly among Gram-negative organisms. They are also highly implicated as a risk factor for Clostridioides difficile infection, and reports of other serious adverse events led to recommendations to restrict their use. Our health system began targeting the reduction in unnecessary fluoroquinolone prescribing in 2018, aiming to promote their safe and effective use. Broad-spectrum cephalosporins are often used as an alternative to fluoroquinolones. We sought to evaluate whether decreased fluoroquinolone use was associated with increased third- and fourth-generation cephalosporin use and whether these changes in utilization impacted other outcomes, including C. difficile infection (CDI) rates and susceptibilities among Gram-negative organisms. Methods: This retrospective descriptive analysis included adult patients who received a fluoroquinolone or broad-spectrum cephalosporin in a three-year time period across a large healthcare system. The primary objective was to evaluate the change in days of therapy (DOT) of fluoroquinolones and third- and fourth-generation cephalosporins. Secondary objectives included rates of resistance among common Gram-negative organisms, CDI, and analyses stratified by antibiotic indication. Results: Cephalosporin use increased by an average of 1.70 DOT/1000 PD per month (p < 0.001). Additionally, fluoroquinolone use decreased by an average of 1.18 DOT/1000 PD per month (p < 0.001). C. difficile infections decreased by 0.37 infections/10,000 patient-days per month (p < 0.001). Resistance to fluoroquinolones remained stable from 2018 to 2020, and a declining trend was observed in 2021. Conclusion: This study demonstrated that reduced fluoroquinolone use in a large healthcare system was associated with increased usage of broad-spectrum cephalosporins, decreased CDI and improvements in resistance patterns.

中文翻译：

---

减少氟喹诺酮类药物使用对头孢菌素使用、敏感性和艰难梭菌感染的影响

背景：氟喹诺酮类药物的过度使用导致了令人担忧的耐药率，尤其是在革兰氏阴性菌中。它们也被高度认为是艰难梭菌感染的危险因素，其他严重不良事件的报告导致建议限制它们的使用。我们的卫生系统从 2018 年开始着手减少不必要的氟喹诺酮类药物处方，以促进其安全有效地使用。广谱头孢菌素通常用作氟喹诺酮类药物的替代品。我们试图评估氟喹诺酮类药物使用减少是否与第三代和第四代头孢菌素使用增加相关，以及这些使用变化是否影响其他结果，包括艰难梭菌革兰氏阴性菌的感染 (CDI) 率和易感性。方法：这项回顾性描述性分析包括在大型医疗保健系统的三年时间段内接受氟喹诺酮类或广谱头孢菌素治疗的成年患者。主要目的是评估氟喹诺酮类和第三代和第四代头孢菌素治疗天数 (DOT) 的变化。次要目标包括常见革兰氏阴性菌的耐药率、CDI 以及按抗生素适应症分层的分析。结果：头孢菌素的使用平均每月增加 1.70 DOT/1000 PD ( p < 0.001)。此外，氟喹诺酮类药物的使用量平均每月减少 1.18 DOT/1000 PD ( p < 0.001)。艰难梭菌每月感染减少 0.37 次/10,000 患者日 ( p < 0.001)。从 2018 年到 2020 年，对氟喹诺酮类药物的耐药性保持稳定，并在 2021 年观察到下降趋势。结论：这项研究表明，在大型医疗保健系统中减少氟喹诺酮类药物的使用与广谱头孢菌素类药物的使用增加、CDI 降低和耐药性改善有关模式。