In this comparison of ceftriaxone versus oxacillin for MSSA osteoarticular infections, there was no difference in treatment success at 3-6 and >6 months following the completion of intravenous antibiotics. Patients receiving oxacillin were more likely to have it discontinued due to toxicity.

The post-hospital transition represents a vulnerable period for patients discharged on new medications. Evidence-based discharge education may improve follow-up adherence and lower readmission rates. [1][2][3] Health literacy and health policy evidence should be considered when developing educational interventions. [4][5][6] Low health literacy is strongly associated with higher mortality. 5 We assessed the impact of a health education intervention on follow-up adherence and unplanned readmission among patients with osteoarticular infections discharged on outpatient parenteral antibiotic therapy (OPAT). 7 This study used a quasi-experimental design. Preintervention patients received usual discharge teaching. Postintervention patients received an educational brochure written at a seventh-grade reading level. Combined teaching from Infectious Diseases (ID) providers emphasized post-hospital care. The brochure was developed using interdisciplinary clinical evidence and health literacy guidelines.This study includes patients age >18 seen on the ID consultation service at Barnes Jewish Hospital between September 2010 and December 2011. Patients must have been discharged on IV antibiotics and have planned follow-up in the ID clinic. This study was approved by the institutional review board.Statistical analysis was performed using SPSS version 18 (IBM SPSS, Chicago, IL). P values <.05 were considered statistically significant. The primary end points were adherence to ID clinic follow-up and readmission because of a defined set of conditions associated with OPAT (including Clostridium difficile and treatment failure).Two hundred patients (100 preintervention and 100 postintervention) with similar demographics met criteria for analysis. There was a significant improvement in follow-up adherence in the postintervention group compared to the preintervention group (P = .02). Readmissions were similar in each group (P = .17). Treatment failure was the most common reason for readmission in both groups.Our intervention demonstrated an improvement in post-hospital follow-up adherence for patients receiving OPAT. Previous studies have demonstrated that similar educational interventions resulted in improved post-hospital follow-up adherence. 1 Discharge education combined with post-discharge support may improve readmissions significantly. 1,2,8 This study was underpowered to analyze the multiple variables leading to treatment failure. Future studies should assess the factors that contribute to treatment failure and readmissions.

Intraosseous (IO) access is a lifesaving alternative to peripheral or central venous access in emergency care. However, emergency physicians and prehospital care providers must be aware of the potential for infectious complications associated with this intervention. We describe the case of a HIV-negative, otherwise immunocompetent adult patient who underwent prehospital insertion of a tibial IO device. Following successful resuscitation, the patient developed tibial osteomyelitis requiring multiple operative debridements, soft tissue coverage, and several courses of prolonged antimicrobial therapy. Skin antisepsis prior to device insertion followed by early device removal are important strategies for reducing the risk of infection associated with IO access.