Prescriber perceptions of fluoroquinolones, extended-spectrum cephalosporins, and infection.

TitlePrescriber perceptions of fluoroquinolones, extended-spectrum cephalosporins, and infection.
Publication TypeJournal Article
Year of Publication2020
AuthorsSzymczak JE, Muller BM, Shakamuri NShankar, Hamilton KW, Gerber JS, Laguio-Vila M, Dumyati GK, Fridkin SK, Guh AY, Reddy SC, Lautenbach E
Corporate AuthorsCDC Prevention Epicenters Program
JournalInfect Control Hosp Epidemiol
Pagination1-7
Date Published2020 May 29
ISSN1559-6834
Abstract

BACKGROUND: Fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) are associated with higher risk of Clostridioides difficile infection (CDI). Decreasing the unnecessary use of FQs and ESCs is a goal of antimicrobial stewardship. Understanding how prescribers perceive the risks and benefits of FQs and ESCs is needed.

METHODS: We conducted interviews with clinicians from 4 hospitals. Interviews elicited respondent perceptions about the risk of ESCs, FQs, and CDI. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach.

RESULTS: Interviews were conducted with 64 respondents (38 physicians, 7 nurses, 6 advance practice providers, and 13 pharmacists). ESCs and FQs were perceived to have many benefits, including infrequent dosing, breadth of coverage, and greater patient adherence after hospital discharge. Prescribers stated that it was easy to make decisions about these drugs, so they were especially appealing to use in the context of time pressures. They described having difficulty discontinuing these drugs when prescribed by others due to inertia and fear. Prescribers were skeptical about targeting specific drugs as a stewardship approach and felt that the risk of a negative outcome from under treatment of a suspected bacterial infection was a higher priority than the prevention of CDI.

CONCLUSIONS: Prescribers in this study perceived many advantages to using ESCs and FQs, especially under conditions of time pressure and uncertainty. In making decisions about these drugs, prescribers balance risk and benefit, and they believed that the risk of CDI was acceptable in compared with the risk of undertreatment.

DOI10.1017/ice.2020.183
Alternate JournalInfect Control Hosp Epidemiol
PubMed ID32468967