Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess

Jenkins, Timothy C; Knepper, Bryan; Sabel, Allison L.; Sarcone, Ellen; Long, Jeremy; Haukoos, Jason S.; Morgan, Steven J.; Biffl, Walter L.; Steele, Andrew; Price, Connie S.; Mehler, Philip S.; Burman, William J.

doi:10.1001/archinternmed.2011.29

Cited by 88 publications

(98 citation statements)

References 40 publications

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“…In several studies, the mean duration of treatment is around two weeks 1,13 , which is inferior to that observed in our study. However, in the study of Jenkins et al, the rate of recurrence was 6%, which can be explained by the antibiotic selected at discharge (trimethoprim-sulfamethoxazole, which has poor Streptococcus cover), and by the short duration of treatment 1 .…”

Section: Discussioncontrasting

confidence: 99%

“…Skin and soft tissue infection is a highly common disease with an increasing number of hospitalisations [1][2][3] , most of them resulting from previous treatment failures 6,13 . However, there is very little evidence regarding what is the best antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The microorganism was recovered more frequently among patients with abscess (15% vs 8%) or cSSTI (56% vs 25%) than in patients with uncomplicated cellutitis (29% vs 67%, p = 0.001). Patients with positive microbiology results had longer duration of treatment (median [IQR]: 18 [15-29.5] vs 15 [12][13][14][15][16][17][18][19] days, p = 0.003) and longer hospital stay (11 [7][8][9][10][11][12][13][14][15][16][17] vs 8 [5][6][7][8][9][10][11][12][13] days, p = 0.014).…”

Section: Discussionmentioning

confidence: 99%

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Tratamiento empírico de pacientes ingresados con infección de piel y partes blandas: ¿cómo lo estamos haciendo?

Pérez-Rodríguez¹,

Argibay²,

Nodar³

et al. 2014

Gal. Clin.

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ResumenObjetivos: Existen diferentes guías de tratamiento de la infección de piel y partes blandas (IPPB), sin embargo el tratamiento de estos pacientes es muy variable. Los objetivos fueron analizar las pautas antibióticas, así como su duración en pacientes con IPPB que precisaron ingreso. Pacientes y métodos: Se revisaron los pacientes con IPPB ingresados entre enero y diciembre de 2009. Se recogieron las pautas de tratamiento antibiótico empleadas antes, durante y tras el ingreso, así como su duración. Resultados: De un total de 131 pacientes con IPPB ingresados, se identificaron 41 pautas diferentes de tratamiento antibiótico. En 61 pacientes (47%) se emplearon dos o más fármacos y en 21 (16%) antibióticos de amplio espectro. En 25 pacientes (19%) se modificó la pauta antibiótica por mala evolución y se utilizaron 16 regímenes antibióticos diferentes. En los pacientes con fracaso del tratamiento antibiótico, ni la duración del ingreso (12 ± 9.0 días vs. 14 ± 8.7 días, p = 0.31), ni la duración del tratamiento antibiótico (12 ± 8.2 días vs. 14 ± 6.8 días, p = 0.33) fueron superiores a la de aquellos en los que la respuesta al tratamiento empírico inicial fue adecuada. Al alta, 95 pacientes (73%) recibieron tratamiento antibiótico, se identificaron 25 regímenes diferentes; 22 pacientes (23%) recibieron dos o más antibióticos y antibióticos de amplio espectro se pautaron en 10 casos. Conclusiones: La IPPB es una causa creciente de hospitalización y, a pesar de existir guías recientes de tratamiento, las pautas de tratamiento antibiótico son altamente variables. Palabras clave: Celulitis; infección de piel y partes blandas; absceso cutáneo; tratamiento antibiótico. AbstractObjetives: There are several clinical guidelines for the management of skin and soft tissue infections (SSTI); however, the empirical treatment of patients with this common cause of hospital admission is highly variable. The aims of this study were to determine the empirical antibiotic treatment regimes and the duration of antibiotic treatment of SSTI requiring hospitalization. Patients and methods: Cases admitted for SSTI were reviewed. We evaluated antibiotic therapy before, during and after hospitalization, as well as duration of treatment. Results: From the 131 patients, 41 different antibiotic regimes were identified. Antibiotic combinations were used in 61 patients (47%) and broadspectrum antibiotics were used in 21 patients (16%). Modification of the antibiotic regimen was required in 25 patients (19%) due to poor clinical response, and 16 different regimes were prescribed. For patients with treatment failure, neither duration of hospitalization (12 ± 9.0 days vs. 14 ± 8.7 days, p = 0.31) nor duration of antibiotic treatment (12 ± 8.2 days vs. 14 ± 6.8 days, p = 0.33) were greater than for those who responded to the initial empirical treatment. On discharge, antibiotic treatment was prescribed for 95 patients (73%), with 25 different regimes, including a combination of drugs in 22 patients (23%) and broad-spectrum antibiotics in 10. Con...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Tratamiento empírico de pacientes ingresados con infección de piel y partes blandas: ¿cómo lo estamos haciendo?

Pérez-Rodríguez¹,

Argibay²,

Nodar³

et al. 2014

Gal. Clin.

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“…18 Little evidence is available about how ASP structures and processes relate to effective AS, and there is a lack of specificity of these structures and processes given the wide range of implementation strategies. The science guiding AS is largely based on uncoordinated, single-site trials that focus on process measures, [19][20][21][22][23][24][25] leaving gaps in evidence that would identify highly effective components and processes for implementation. For example, audit and feedback have often been cited as an effective strategy, 26 yet their targets and implementation strategies remain unclear.…”

mentioning

confidence: 99%

Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey

Chou

Graber

Jones

et al. 2016

Infect. Control Hosp. Epidemiol.

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BACKGROUNDAntimicrobial stewardship programs (ASPs) are variably implemented.OBJECTIVETo characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage.DESIGNA web-based survey regarding stewardship activities was administered to each facility’s designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined.SETTINGTotal of 130 Veterans Affairs facilities with inpatient services.RESULTSOf 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03).CONCLUSIONSASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices.Infect Control Hosp Epidemiol 2016;37:647–654

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“…Acute bacterial skin and skin structure infections are among the most common reasons for hospitalization of adults (1). These infections are most often caused by Staphylococcus aureus and streptococci (2).…”

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confidence: 99%

Dalbavancin, Oritavancin and Tedizolid are Safe and Effective for Skin Infection Treatment

Mardani

2014

Arch Clin Infect Dis

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Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess

Abstract: Implementation of a guideline for the management of inpatient cellulitis and cutaneous abscess led to shorter durations of more targeted antibiotic therapy and decreased use of resources without adversely affecting clinical outcomes.

Cited by 88 publications

References 40 publications

Tratamiento empírico de pacientes ingresados con infección de piel y partes blandas: ¿cómo lo estamos haciendo?

Tratamiento empírico de pacientes ingresados con infección de piel y partes blandas: ¿cómo lo estamos haciendo?

Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey

Dalbavancin, Oritavancin and Tedizolid are Safe and Effective for Skin Infection Treatment

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