Early clinical assessment of response to treatment of skin and soft-tissue infections: how can it help clinicians? Perspectives from Europe

Abstract

Skin and soft-tissue infections (SSTIs) are a common indication for antibiotic use in Europe and are associated with considerable morbidity. Treatment of SSTIs, occasionally complicated by infection with meticillin-resistant Staphylococcus aureus, can be resource intensive and lead to high healthcare costs. For patients treated in an inpatient setting, once the acute infection has been controlled, a patient may be discharged on suitable oral antibiotic therapy or outpatient parenteral antibiotic therapy. The recently confirmed efficacy of single-dose (e.g. oritavancin) and two-dose (e.g. dalbavancin) infusion therapies as well as tedizolid phosphate, a short-duration therapy available both for intravenous (i.v.) and oral use, for treating SSTIs has highlighted the need for clinicians to re-evaluate their current treatment paradigms. In addition, recent clinical trial data reporting a novel endpoint of early clinical response, defined as change in lesion size at 48-72 h, may be of value in determining which patients are most suitable for early de-escalation of therapy, including switch from i.v. to oral antibiotics, and subsequent early hospital discharge. The aim of this paper is to review the potential impact of assessing clinical response on clinical decision-making in the management of SSTIs in Europe, with a focus on emerging therapies.

Attitudes of physicians from 10 European countries on adherence and how treatment modalities in ABSSSI affect adherence: results from a Delphi survey

“…Administration regimen and drug selection for ABSSSI’s treatment emerged as crucial factors for adherence. After initial treatment, patients may be switched to a suitable oral AB, or to outpatient parenteral antibiotic therapy (OPAT) [ 2 ]. In general, outpatient costs are lower, but treatments often require multiple and long infusions, loading on the healthcare systems and HCP utilization [ 17 ].…”

“…Acute bacterial skin and skin structure infections (ABSSSI) are one of the most frequent causes of hospitalization among skin and soft-tissue infections (SSTIs) [ 1 , 2 ]. Management of ABSSSI is complex and includes surgical procedures and antibiotic (AB) treatment [ 1 , 3 ].…”

Open-Label Randomized Trial of Early Clinical Outcomes of Ceftaroline Fosamil Versus Vancomycin for the Treatment of Acute Bacterial Skin and Skin Structure Infections at Risk of Methicillin-Resistant Staphylococcus aureus

“…In fact, the results of the DISCOVER trial have been used to highlight the lack of clinical relevance of this end point for determining successful outcomes [ 19 ]. This is not without controversy, however [ 20 ]. A recently published pooled analysis of ESTABLISH trials reported a high predictive value for clinical cure [ 20 , 21 ].…”

Retrospective Real-World Evaluation of Outcomes in Patients with Skin and Soft Structure Infections Treated with Tedizolid in an Outpatient Setting

“…Patients with skin infections may be admitted solely to receive intravenous (IV) antibacterial agents despite having few, if any, comorbid conditions or any systemic signs/symptoms of infection [9,10]. Furthermore, patients often remain hospitalized even after their acute infection resolves, and it is possible to discharge these patients with continued oral antibiotic therapy without compromising their outcomes [10,11]. A survey of 94 patients with skin infections across six US hospital emergency departments (EDs) revealed that 40% of patients preferred to be treated at home [12].…”