5PSQ-107 Compliance of fluoroquinolones prescriptions: a hospital acquired resistance?

Background and Importance In Europe, the annual death toll from antibiotic-resistant bacteria has risen from 25,000 to 35,0001. In 2020, France reported a 16% resistance rate to fluoroquinolone (FQ) in hospital2. FQ are no longer recommended as first-line treatment and are restricted to some urinary, pulmonary, intra-abdominal, soft tissue infections, and bacteraemia cases. Aim and Objectives This study aims to assess the compliance of FQ prescriptions with guidelines provided by the local healthcare product safety commission, Summaries of Product Characteristics, and the French Society of Infectious Pathology (SPLIF). Material and Methods The study (1 December 2022 -to 1 May 2023) was conducted across the following specialties: hepatogastroenterology, vascular medicine, home hospitalisation, neurology, ophthalmology, dermatology, haematology, and intensive care departments. Using the DxCare® prescription software, ciprofloxacin, ofloxacin, levofloxacin, and moxifloxacin were analysed, focusing on the conformity of: indication, dosage, duration, documentation, the interval between two FQ, and pharmaceutical validation. Results 197 prescriptions were extracted. 100% were validated. 41% (81) were compliant. Compliance rates were 85% (168) for indications and 94% (185) for dosage. 59% of prescriptions (117) were first line, 33% (65) second line, 5% (9) third line, and 2% (3) fourth line. 70% (137) adhered to the recommended treatment duration and 83% (164) respected the minimum 6-month interval between two FQ. 47% (92) of prescriptions were documented, 34% (67) were probabilistic, and 19% (39) were prophylaxis, of which 13 (30%) were compliant. 85% of strains were sensitive to FQ, with 16% sensitive at higher doses, and 3% exhibiting resistance. Among the 59% non-compliant prescriptions (116), indications were principally: 5% male urinary tract (10), 6% skin and soft tissue (12), 9% (17) for both pulmonary and female urinary tract. Conclusion and Relevance Considering the high rate of non-compliant prescriptions (59%), there is a need to review internal guidelines of the principal non-compliant infections, to be more intuitive. We could produce an informational note to physicians and pharmacists to emphasise the need to adhere to strict indications and to document infections, since less than half were documented. This was a 6-month study in select hospital departments, it could have been extended to the university hospital centre in 2022. References and/or Acknowledgements 1. Position Paper on Infectious Diseases, EAHP. 2. Mission PRIMO, SPF. Conflict of Interest No conflict of interest.