Objective Hospitalizations for acute bacterial skin and skin structure infection (ABSSSI) are common. Optimizing antibiotic use for ABSSSIs requires an understanding of current management. The objective of this study was to evaluate antibiotic prescribing practices and factors affecting prescribing in a diverse group of hospitals. Design Multicenter, retrospective cohort study Setting Seven community and academic hospitals Methods Children and adults hospitalized between June 2010 and May 2012 for cellulitis, wound infection, or cutaneous abscess were eligible. The primary endpoint was a composite of two prescribing practices representing potentially avoidable antibiotic exposure: 1) use of antibiotics with a broad spectrum of activity against gram-negative bacteria; or 2) treatment duration >10 days. Results 533 cases were included: 320 with non-purulent cellulitis, 44 with wound infection or purulent cellulitis, and 169 with abscess. Of 492 cases with complete prescribing data, the primary endpoint occurred in 394 (80%) cases and varied significantly across hospitals (64 – 97%, p<.001). By logistic regression, independent predictors of the primary endpoint included wound infection or purulent cellulitis (odds ratio [OR] 5.12, 95% confidence interval [CI] 1.46 – 17.88), head or neck involvement (OR 2.83, 95%CI 1.17 – 6.82), adult cases (OR 2.20, 95%CI 1.18 – 4.11), and admission to a community hospital (OR 1.90, 95%CI 1.05 – 3.44). Conclusions Among patients hospitalized for ABSSSI, use of antibiotics with broad gram-negative activity or treatment courses longer than 10 days were common. There may be substantial opportunity to reduce antibiotic exposure through shorter courses of therapy targeting gram-positive bacteria.

Background Hospitalizations for acute bacterial skin and skin structure infection (ABSSSI) in children are increasingly frequent, but little is known about antibiotic utilization. In adults, recent studies suggest substantial opportunity to reduce broad-spectrum antibiotic use and shorten therapy. We sought to determine whether similar opportunity exists in children. Methods This was a planned secondary analysis of a pediatric cohort taken from a multicenter, retrospective cohort of patients hospitalized for ABSSSI between June 1, 2010 and May 31, 2012. The pre-specified primary endpoint was a composite of two prescribing practices: 1) use of antibiotics with broad Gram-negative activity, or 2) treatment duration >10 days. Results 102 patients ≤18 years old were included: 43 had non-purulent cellulitis, 19 had wound infection or purulent cellulitis, and 40 had cutaneous abscess. The median age was 5 years (range 45 days to 18 years). Clindamycin was the most frequently prescribed antibiotic during hospitalization (67% of cases) and at discharge (66% of cases). The median duration of therapy was 11 days (interquartile range 10 – 12) and was similar for all three types of ABSSSI. The primary endpoint occurred in 67% of cases, including broad Gram-negative therapy in 25% and treatment duration >10 days in 61%. By multivariate logistic regression, admission via an emergency department and management by a medical (vs. surgical) service were independently associated with the primary endpoint. Conclusions Children hospitalized for ABSSSI are frequently exposed to antibiotics with broad Gram-negative activity or treated longer than 10 days suggesting opportunity to reduce antibiotic use.