Treatment Failure and Costs in Patients With Methicillin-Resistant Staphylococcus aureus (MRSA) Skin and Soft Tissue Infections: A South Texas Ambulatory Research Network (STARNet) Study

The purpose of this study was to evaluate risk factors for failure of antibiotic treatment within 30 days for uncomplicated skin infections of outpatients treated in a Veterans Affairs hospital. A retrospective chart review of outpatients between January 2006 and July 2015 with an ICD-9 (International Statistical Classification of Diseases and Related Health Problems) code of cellulitis or abscess was included in the analysis. The primary outcome was success versus failure of the antibiotic, with failure defined as another antibiotic prescribed or hospitalization within 30 days for the original indication. A total of 293 patients were included in the final analysis, 24% of whom failed within 30 days. Obesity/ overweight (body mass index [BMI] of Ͼ25 kg/m 2 ) was identified in 83% of the overall population, with 16% of that population having a BMI greater than 40 kg/m 2 . An elevated mean BMI of 34.2 kg/m 2 (P ϭ 0.0098) was found in the subset of patients who failed oral antibiotics compared to a BMI of 31.32 kg/m 2 in patients who were treated successfully. Additionally, the patients who failed had an increased prevalence of heart failure at 16% (P ϭ 0.027). Using multivariate logistic regression, BMI and heart failure were determined to be significant predictors of antibiotic prescription failure. Each 10-kg/m 2 unit increase in BMI was associated with a 1.62-fold-greater odds of failure. A diagnosis of heart failure increased the odds of failure by 2.6-fold (range, 1.1-to 5.8-fold). Outpatients with uncomplicated skin infections with an elevated BMI and heart failure were found to have increased odds of failure, defined as hospitalization or additional antibiotics within 30 days.

Section: Discussioncontrasting

confidence: 53%

“…In the literature, the overall treatment failure rate of oral antibiotics ranges from 10% to 21% (3)(4)(5)(6)(7). One study found that the mean additional cost associated with antibiotic failure was $1,934 per patient (5).…”

mentioning

confidence: 99%

Obesity and Heart Failure as Predictors of Failure in Outpatient Skin and Soft Tissue Infections

Conway

Sellick

Kurtzhalts

et al. 2017

“…Skin infections are a common clinical problem resulting in substantial clinical morbidity, hospitalization, and cost (1,2,24). In this study, postdischarge adherence to antibiotic therapy for S. aureus skin infection was low (57%) and associated with poor clinical outcome.…”

Section: Discussionmentioning

confidence: 88%

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

Eells

Nguyen

Jung

et al. 2016

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...

“…Although these are often mild infections, they can lead to severe invasive diseases such as bacteremia, endocarditis, osteomyelitis, and sepsis. S. aureus infections can also be difficult to completely eradicate even when the infecting isolate is susceptible to antibiotics (3,4). This is further complicated by the emergence and spread of methicillin-resistant S. aureus (MRSA) along with an increasing incidence of resistance to macrolides, aminoglycosides, and fluoroquinolones (5) and more recently linezolid (LZD) (6,7).…”

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confidence: 99%

Anti-Alpha-Toxin Monoclonal Antibody and Antibiotic Combination Therapy Improves Disease Outcome and Accelerates Healing in a Staphylococcus aureus Dermonecrosis Model

Hilliard¹,

Datta²,

Tkaczyk³

et al. 2015

c Alpha-toxin (AT) is a major virulence determinant in Staphylococcus aureus skin and soft tissue infection models. We previously demonstrated that prophylactic administration of 2A3, an AT-neutralizing monoclonal antibody (MAb), prevents S. aureus disease in a mouse dermonecrosis model by neutralizing AT-mediated tissue necrosis and immune evasion. In the present study, MEDI4893*, an affinity-optimized version of 2A3, was characterized for therapeutic activity in the dermonecrosis model as a single agent and in combination with two frontline antibiotics, vancomycin and linezolid. MEDI4893* postinfection therapy was found to exhibit a therapeutic treatment window similar to that for linezolid but longer than that for vancomycin. Additionally, when combined with either vancomycin or linezolid, MEDI4893* resulted in reduced tissue damage, increased neutrophil and macrophage infiltration and abscess formation, and accelerated healing relative to those with the antibiotic monotherapies. These data suggest that AT neutralization with a potent MAb holds promise for both prophylaxis and adjunctive therapy with antibiotics and may be a valuable addition to currently available options for the treatment of S. aureus skin and soft tissue infections.