Trends in Fluoroquinolone, Cephalosporin Use and C Diff Rates at VA Health Care Facilities

Segment Description: Vanessa Stevens, PhD, a researcher with the VA Salt Lake City Health Care System and a research assistant professor in the Division of Epidemiology, Department of Internal Medicine, at the University of Utah, discusses her research on fluoroquinolone and cephalosporin prescribing and rates of Clostridium difficile infections at VA health care facilities.

Interview transcript (modified slightly for readability):

Contagion®: What was the biggest takeaway from your research on FQ and cephalosporin prescribing trends and C diff rates?

Vanessa Stevens, PhD: We've been noticing that there has been a significant decrease in fluoroquinolone use across the VA health care system, which is the largest health care system in the US with more than 120 acute care and 120 long-term care facilities. We wanted to really take a closer look at changes in fluoroquinolone prescribing, but also potentially look for some broad-spectrum agents that people might be using to replace fluoroquinolones and look at the relationship with the onset of hospital-acquired Clostridium difficile infection in the health care system. What we found was that there was a 50% decrease in fluoroquinolone use over the 11 years of the study, from 2006 to 2016, and a 50% decrease in hospital-onset or health care-acquired C diff over the same period. We also noticed that, toward the very end of the study in 2014, there was a slight increase in cephalosporin use. For the rest of the study period, it had been relatively flat, but toward the end we started to notice an uptick, which is a little bit concerning because this is an agent that also predisposes patients to Clostridium difficile. We're making great strides with fluoroquinolone use, but we need to be a little bit careful about what we're using to replace those agents.

Contagion®: What’s next in this line of research?

Vanessa Stevens, PhD: The antimicrobial stewardship activities across the VA are diverse. There's a very strong network of professionals dedicated to antimicrobial stewardship and people try out lots of different practices and so the next line of research is really to drill down to these individual practices and see which activities have had the greatest success. We're going to look at individual facilities and see how their programs have been going, how their progress is going, and we would also like to look at some of the other other agents besides cephalosporins to see what's happening with those in terms of use in the absence of or the decrease in fluoroquinolone use.

I think 1 other thing that was really interesting is we looked at what periods in time there were substantial changes in fluoroquinolone use within our health care system and they pretty closely mirrored the releases of black box warnings and label enhancements issued by the FDA. The process in the VA is whenever there's a release from the FDA, the VA actually sends out supplementary information to all of its antimicrobial stewardship providers and prescribers on the frontline and also supplements that with webinars, so it was very interesting to see how the changes in fluoroquinolones pretty closely—not perfectly, but pretty closely—mirrored those time points.

The study, "Trends in fluoroquinolone and cephalosporin prescribing and Clostridioides difficile infections in acute and long-term care facilities in the US Department of Veterans Affairs Health System," was presented as a mini oral ePoster on April 13, 2019, at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2019) in Amsterdam, the Netherlands.