Appropriateness of antibiotic management of uncomplicated skin and soft tissue infections in hospitalized adult patients

Abstract

BackgroundSkin and soft tissue infections (SSTIs) are a leading cause for hospitalizations in the United States. Few studies have addressed the appropriateness of antibiotic therapy in the management of SSTIs without complicating factors. We aimed to determine the appropriateness of antibiotic treatment duration for hospitalized adult patients with uncomplicated SSTIs.MethodsThis was a retrospective analysis performed at two academic medical centers in Pittsburgh, Pennsylvania on patients aged 18 years and older with primary ICD-9 code for SSTIs admitted August 1st, 2014–March 31st, 2015. The primary outcome was the appropriateness of antibiotic treatment duration for uncomplicated SSTIs. Secondary objectives included the appropriateness of antibiotic agent spectrum, duration of inpatient length of stay (LOS), utilization of blood cultures and advanced imaging modalities, and re-hospitalization for SSTI within 30 days of discharge from the index admission.ResultsA total of 163 episodes were included in the cohort. The mean duration of total antibiotic therapy was 12.6 days. Appropriate duration was defined as receipt of total antibiotic duration of less than 10 days and occurred in 20.2% of patients. Twenty eight percent of patients received antibiotics for greater than 14 days. Seventy three (44.8%) patients received greater than 24 h of inappropriate extended spectrum gram-negative coverage; 65 (39.9%) received anaerobic coverage.ConclusionsIn the majority of patients, treatment duration was excessive. Inappropriate broad spectrum antibiotic selection was utilized with regularity for SSTIs without complicating factors. The management of uncomplicated SSTIs represents a significant opportunity for antimicrobial stewardship.

The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands

“…Finally, antibiotic use for respiratory tract infections has received extensive attention from ASPs, which might have led to less inappropriate prescriptions [7,8,23,24]. In previous studies it was already shown that antimicrobial treatment of uncomplicated SSTI had a low guideline adherence rate, 11-20.2%, due to an inappropriate length of treatment and due to an inappropriate choice of broad spectrum antibiotic agents [9,26,27]. Altogether, these findings suggest that there is considerable room for quality improvement for SSTI prescriptions and emphasize the need of information on antibiotic use per clinical care setting to direct ASP efforts [10,24].…”

Skin Surface Temperatures Measured by Thermal Imaging Aid in the Diagnosis of Cellulitis

“…In this study, we did not evaluate the role of thermal imaging in monitoring response to treatment. Many studies suggest that cellulitis is treated with excessively long courses of antibiotics (Jenkins et al, 2010;Walsh et al, 2016). Montalto et al (2013) previously used successive thermal imaging measurements to determine whether they indicated resolution of infection.…”

Potential savings through single-dose intravenous Dalbavancin in long-term MRSA infection treatment – a health economic analysis using German DRG data

“…Especially in diseases such as osteomyelitis, skin and soft tissue infections or endocarditis, antibiotic durations up to 3–6 weeks are possible [1], [2], [3], [4], [5], [6], [7], [8]. Patients with Methicillin-resistant Staphylococcus aureus (MRSA) infections stay in hospital for even longer [9], [10].…”