Relationship between Adherence to Oral Antibiotics and Postdischarge Clinical Outcomes among Patients Hospitalized with Staphylococcus aureus Skin Infections

Abstract

e Skin and soft tissue infections are common and frequently recur. Poor adherence to antibiotic therapy may lead to suboptimal clinical outcomes. However, adherence to oral antibiotic therapy for skin and soft tissue infections and its relationship to clinical outcomes have not been examined. We enrolled adult patients hospitalized with uncomplicated skin and soft tissue infections caused by Staphylococcus aureus who were being discharged with oral antibiotics to complete therapy. We fit the participants' pill bottles with an electronic bottle cap that recorded each pill bottle opening, administered an in-person standardized questionnaire at enrollment, 14 days, and 30 days, and reviewed the participants' medical records to determine outcomes. Our primary outcome was poor clinical response, defined as a change in antibiotic therapy, new incision-and-drainage procedure, or new skin infection within 30 days of hospital discharge. Of our 188 participants, 87 had complete data available for analysis. Among these participants, 40 (46%) had a poor clinical response at 30 days. The mean electronically measured adherence to antibiotic therapy was significantly different than the self-reported adherence (57% versus 96%; P < 0.0001). In a multivariable model, poor clinical response at 30 days was associated with patients having lower adherence, being nondiabetic, and reporting a lack of illicit drug use within the previous 12 months (P < 0.05). In conclusion, we found that patient adherence to oral antibiotic therapy for a skin and soft tissue infection after hospital discharge was low (57%) and associated with poor clinical outcome. Patients commonly overstate their medication adherence, which may make identification of patients at risk for nonadherence and poor outcomes challenging. Further studies are needed to improve postdischarge antibiotic adherence after skin and soft tissue infections. Skin infections are a common reason for physician visits and hospital admission (1, 2). Staphylococcus aureus is the most common cause of skin infections in the community (3, 4). Recurrent and/or relapse skin infections are commonly reported after an initial S. aureus skin infection (5-7). Rates of recurrence have exceeded 50% in some populations (5,8,9).Reasons for the failure of a skin infection to resolve are poorly understood but are likely to be due to host and behavior factors, inadequate medical and/or surgical therapy, and possibly pathogen-associated factors (10). In other chronic and acute infections, medication adherence is frequently suboptimal and associated with worse clinical outcomes (11-13). However, there are no studies to date evaluating antibiotic adherence, or the relationship between adherence and clinical outcome, among patients experiencing skin infections.Poor adherence to medication regimens is common across all disease entities. Low adherence contributes to a worsening of the patient's condition, death, and increased health care costs (14). Even in clinical trials, where study participants receive increas...

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“…In addition, a recent article measuring the postdischarge adherence to oral antibiotics by an electronic bottle cap that recorded each pill bottle opening demonstrated a significant difference between self-reported adherence and electronically measured adherence (57% versus 96%; P Ͻ 0.0001) (12). In this study, poor adherence was associated with a lower clinical response at 30 days.…”

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“…Due to the retrospective nature of this study, we were unable to assess adherence in either group. Adherence to PO antibiotics when measured using the Medication Event Monitoring System (Aprex, Union City, CA, USA) was reported to be between 18% and 57% . In comparison, adherence to antibiotics for patients receiving outpatient parenteral antibiotic therapy (OPAT) is consistently at or above 80% …”

“…Adherence to PO antibiotics when measured using the Medication Event Monitoring System (Aprex, Union City, CA, USA) was reported to be between 18% and 57%. [21][22][23] In comparison, adherence to antibiotics for patients receiving outpatient parenteral antibiotic therapy (OPAT) is consistently at or above 80%. 24,25 A study including 333 patient in the Veterans Administration system reported that 87% of patients who were defined as homeless successfully completed a defined course of parenteral antibiotic therapy.…”

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“…Studies show that the compliance of patients depends on various factors and is often low [41], [42], [43]. For example, Eells et al state that patient adherence to oral antibiotic therapy for SSTI after hospital discharge was only 57 percent, which was associated with poor clinical outcomes [43]. Thus, a single-dose intravenous Dalbavancin is an option for patients where the LOS can be significantly reduced.…”