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Antibiotic Prescribing Practices in a Multicenter Cohort of Patients Hospitalized for Acute Bacterial Skin and Skin Structure Infection

Published online by Cambridge University Press:  10 May 2016

Timothy C. Jenkins ,
Bryan C. Knepper ,
S. Jason Moore ,
Sean T. O’Leary ,
Brooke Caldwell ,
Carla C. Saveli ,
Sean W. Pawlowski ,
Daniel M. Perlman ,
Bruce D. McCollister  and
William J. Burman
Timothy C. Jenkins*
Affiliation:
Department of Medicine and Division of Infectious Diseases, Denver Health, Denver, Colorado Department of Medicine and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
Bryan C. Knepper
Affiliation:
Department of Patient Safety and Quality, Denver Health, Denver, Colorado
S. Jason Moore
Affiliation:
Department of Trauma and Critical Care Services, Vail Valley Medical Center, Vail, Colorado
Sean T. O’Leary
Affiliation:
Department of Medicine and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado Department of Medicine, Children’s Hospital Colorado, Aurora, Colorado Division of Infectious Diseases, Children’s Hospital Colorado, Aurora, Colorado
Brooke Caldwell
Affiliation:
Department of Medicine, Children’s Hospital Colorado, Aurora, Colorado
Carla C. Saveli
Affiliation:
Department of Medicine and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
Sean W. Pawlowski
Affiliation:
Colorado Infectious Disease Associates, Denver, Colorado
Daniel M. Perlman
Affiliation:
Department of Medicine, Porter Adventist Medical Center, Denver, Colorado
Bruce D. McCollister
Affiliation:
Department of Medicine and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado Department of Medicine and Division of Infectious Diseases, Denver Veterans Affairs Medical Center, Denver, Colorado
William J. Burman
Affiliation:
Department of Medicine and Division of Infectious Diseases, Denver Health, Denver, Colorado Department of Medicine and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado Denver Public Health, Denver Health, Denver, Colorado
*
660 Bannock Street, Denver, CO 80204 ([email protected]).
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Abstract

Objective.

Hospitalizations for acute bacterial skin and skin structure infection (ABSSSI) are common. Optimizing antibiotic use for ABSSSIs requires an understanding of current management. The objective of this study was to evaluate antibiotic prescribing practices and factors affecting prescribing in a diverse group of hospitals

Design.

Multicenter, retrospective cohort study.

Setting.

Seven community and academic hospitals.

Methods.

Children and adults hospitalized between June 2010 and May 2012 for cellulitis, wound infection, or cutaneous abscess were eligible. The primary endpoint was a composite of 2 prescribing practices representing potentially avoidable antibiotic exposure: (1) use of antibiotics with a broad spectrum of activity against gram-negative bacteria or (2) treatment duration greater than 10 days.

Results.

A total of 533 cases were included: 320 with nonpurulent cellulitis, 44 with wound infection or purulent cellulitis, and 169 with abscess. Of 492 cases with complete prescribing data, the primary endpoint occurred in 394 (80%) cases and varied significantly across hospitals (64%–97%; P < .001). By logistic regression, independent predictors of the primary endpoint included wound infection or purulent cellulitis (odds ratio [OR], 5.12 [95% confidence interval (CI)], 1.46–17.88), head or neck involvement (OR, 2.83 [95% CI, 1.17–6.82]), adult cases (OR, 2.20 [95% CI, 1.18–4.11]), and admission to a community hospital (OR, 1.90 [95% CI, 1.05–3.44]).

Conclusions.

Among patients hospitalized for ABSSSI, use of antibiotics with broad gram-negative activity or treatment courses longer than 10 days were common. There may be substantial opportunity to reduce antibiotic exposure through shorter courses of therapy targeting gram-positive bacteria.

Infect Control Hosp Epidemiol 2014;35(10):1241–1250

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 10 , October 2014 , pp. 1241 - 1250
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. US Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Antibiotic Resistance Threats in the United States, 2013. Atlanta: CDC, 2013. http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013–508.pdf. Accessed October 1, 2013.Google Scholar
2. Bartlett, JG, Gilbert, DN, Spellberg, B. Seven ways to preserve the miracle of antibiotics. Clin Infect Dis 2013;56(10):1445–1450.CrossRefGoogle ScholarPubMed
3. Edelsberg, J, Taneja, C, Zervos, M, et al. Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis 2009;15(9):1516–1518.Google Scholar
4. Hersh, AL, Chambers, HF, Maselli, JH, Gonzales, R. National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med 2008;168(14):1585–1591.Google Scholar
5. Lopez, MA, Cruz, AT, Kowalkowski, MA, Raphael, JL. Trends in resource utilization for hospitalized children with skin and soft tissue infections. Pediatrics 2013;131(3):e718–e725.Google Scholar
6. Lautz, TB, Raval, MV, Barsness, KA. Increasing national burden of hospitalizations for skin and soft tissue infections in children. J Pediatr Surg 2011;46(10):1935–1941.Google Scholar
7. Liu, C, Bayer, A, Cosgrove, SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 2011;52(3):285–292.CrossRefGoogle Scholar
8. Jenkins, TC, Sabel, AL, Sarcone, EE, Price, CS, Mehler, PS, Burman, WJ. Skin and soft-tissue infections requiring hospitalization at an academic medical center: opportunities for antimicrobial stewardship. Clin Infect Dis 2010;51(8):895–903.Google Scholar
9. Carratala, J, Roson, B, Fernandez-Sabe, N, et al. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis 2003;22(3):151–157.Google Scholar
10. Amara, S, Adamson, RT, Lew, I, Huang, X. Clinical response at day 3 of therapy and economic outcomes in hospitalized patients with acute bacterial skin and skin structure infection (ABSSSI). Curr Med Res Opin 2013;29(7):869–877.Google Scholar
11. Jenkins, TC, Knepper, BC, Sabel, AL, et al. Decreased antibiotic utilization after implementation of a guideline for inpatient cellulitis and cutaneous abscess. Arch Intern Med 2011;171(12):1072–1079.CrossRefGoogle ScholarPubMed
12. Gilbert, EH, Lowenstein, SR, Koziol-McLain, J, Barta, DC, Steiner, J. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med 1996;27(3):305–308.Google Scholar
13. US Department of Health and Human Services, Food and Drug Administration (FDA), Center for Drug Evaluation and Research. Guidance for Industry: Acute Bacterial Skin and Skin Structure Infections: Developing Drugs for Treatment. Silver Spring, MD: FDA, 2010. http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071185.pdf. Accessed February 6, 2013.Google Scholar
14. Lipsky, BA, Weigelt, JA, Gupta, V, Killian, A, Peng, MM. Skin, soft tissue, bone, and joint infections in hospitalized patients: epidemiology and microbiological, clinical, and economic outcomes. Infect Control Hosp Epidemiol 2007;28(11):1290–1298.Google Scholar
15. Pallin, DJ, Egan, DJ, Pelletier, AJ, Espinola, JA, Hooper, DC, Camargo, CA Jr. Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus . Ann Emerg Med 2008;51(3):291–298.Google Scholar
16. Huttner, B, Jones, M, Huttner, A, Rubin, M, Samore, MH. Antibiotic prescription practices for pneumonia, skin and soft tissue infections and urinary tract infections throughout the US Veterans Affairs system. J Antimicrob Chemother 2013;68(10):2393–2399.Google Scholar
17. Qualls, ML, Mooney, MM, Camargo, CA Jr, Zucconi, T, Hooper, DC, Pallin, DJ. Emergency department visit rates for abscess versus other skin infections during the emergence of community-associated methicillin-resistant Staphylococcus aureus, 1997–2007. Clin Infect Dis 2012;55(1):103–105.Google Scholar
18. Prokocimer, P, De Anda, C, Fang, E, Mehra, P, Das, A. Tedizolid phosphate vs linezolid for treatment of acute bacterial skin and skin structure infections: the ESTABLISH-1 randomized trial. JAMA 2013;309(6):559–569.Google Scholar
19. Joseph, WS, Lipsky, BA. Medical therapy of diabetic foot infections. J Vasc Surg 2010;52(3 suppl):67S–71S.Google Scholar
20. Schmitz, GR, Bruner, D, Pitotti, R, et al. Randomized controlled trial of trimethoprim-sulfamethoxazole for uncomplicated skin abscesses in patients at risk for community-associated methicillin-resistant Staphylococcus aureus infection. Ann Emerg Med 2010;56(3):283–287.CrossRefGoogle ScholarPubMed
21. Duong, M, Markwell, S, Peter, J, Barenkamp, S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med 2010;55(5):401–407.CrossRefGoogle ScholarPubMed
22. Sigurdsson, AF, Gudmundsson, S. The etiology of bacterial cellulitis as determined by fine-needle aspiration. Scand J Infect Dis 1989;21(5):537–542.Google Scholar
23. Hook, EW 3rd, Hooton, TM, Horton, CA, Coyle, MB, Ramsey, PG, Turck, M. Microbiologic evaluation of cutaneous cellulitis in adults. Arch Intern Med 1986;146(2):295–297.Google Scholar
24. Zhang, Y, Steinman, MA, Kaplan, CM. Geographic variation in outpatient antibiotic prescribing among older adults. Arch Intern Med 2012;172(19):1465–1471.Google Scholar