A prospective observational cohort study in primary care practices to identify factors associated with treatment failure in Staphylococcus aureus skin and soft tissue infections

Lee, Grace C.; Hall, Ronald G.; Boyd, Natalie K.; Dallas, Steven D.; Du, Liem C.; Treviño, Lucina B.; Treviño, Sylvia; Retzloff, Chad; Lawson, Kenneth A.; Wilson, James P.; Olsen, Randall J.; Wang, Yufeng; Frei, Christopher R.

doi:10.1186/s12941-016-0175-8

Cited by 9 publications

(6 citation statements)

References 28 publications

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“…In our study, 39% of patients overall experienced at least one adverse outcome, which is higher than has previously described in primary care based studies that reported failure rates of between 10% [36] and 21% [37]. This discrepancy may be explainable by our chosen study population (hospitalised patients, rather than those managed in the primary care setting), but our study does raise questions about whether particular virulence characteristics might exist among the S. aureus clones circulating in this region.…”

Section: Discussioncontrasting

confidence: 67%

The rise of methicillin resistantStaphylococcus aureus: now the dominant cause of skin and soft tissue infection in Central Australia

et al. 2017

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This study aimed to examine the epidemiology and treatment outcomes of community-onset purulent staphylococcal skin and soft tissue infections (SSTI) in Central Australia. We performed a prospective observational study of patients hospitalised with community-onset purulent staphylococcal SSTI (n = 160). Indigenous patients accounted for 78% of cases. Patients were predominantly young adults; however, there were high rates of co-morbid disease. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was the dominant phenotype, accounting for 60% of cases. Hospitalisation during the preceding 6 months, and haemodialysis dependence were significant predictors of CA-MRSA infection on univariate analysis. Clinical presentation and treatment outcomes were found to be comparable for methicillin-susceptible S. aureus (MSSA) and methicillin-resistant cases. All MRSA isolates were characterised as non-multi-resistant, with this term used interchangeably with CA-MRSA in this analysis. We did not find an association between receipt of an active antimicrobial agent within the first 48 h, and progression of infection; need for further surgical debridement; unplanned General Practitioner or hospital re-presentation; or need for further antibiotics. At least one adverse outcome was experienced by 39% of patients. Clindamycin resistance was common, while rates of trimethoprim-sulfamethoxazole resistance were low. This study suggested the possibility of healthcare-associated transmission of CA-MRSA. This is the first Australian report of CA-MRSA superseding MSSA as the cause of community onset staphylococcal SSTI.

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Section: Discussioncontrasting

confidence: 67%

The rise of methicillin resistantStaphylococcus aureus: now the dominant cause of skin and soft tissue infection in Central Australia

et al. 2017

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“…In an observational study of 106 patients with S. aureus SSTIs, in which 21% failed treatment, independent predictors of failure were infection duration of 7 days or more (OR: 6.02) and a lesion diameter of 5 cm or more (OR: 5.25). 78 In addition, the rate of inappropriate antibiotic selection was higher in patients failing treatment, compared with those not failing treatment, although the difference was not statistically significant (11% versus 4%, p = 0.20). In children, fever has been observed to double the risk of initial treatment failure.…”

Section: Unfavorable Outcomes With Inappropriate Absssi Managementmentioning

confidence: 85%

Management of acute bacterial skin and skin structure infections with a focus on patients at high risk of treatment failure

Pulido-Cejudo

Guzmán-Gutiérrez

Jalife-Montaño

et al. 2017

Therapeutic Advances in Infection

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Over the last 25 years, the terminology of skin and soft tissue infections, as well as their classification for optimal management of patients, has changed. The so-called and recently introduced term 'acute bacterial skin and skin structure infections' (ABSSSIs), a cluster of fairly common types of infection, including abscesses, cellulitis, and wound infections, require an immediate effective antibacterial treatment as part of a timely and cautious management. The extreme level of resistance globally to many antibiotic drugs in the prevalent causative pathogens, the presence of risk factors of treatment failure, and the high epidemic of comorbidities (e.g. diabetes and obesity) make the appropriate selection of the antibiotic for physicians highly challenging. The selection of antibiotics is primarily empirical for ABSSSI patients which subsequently can be adjusted based on culture results, although rarely available in outpatient management. There is substantial evidence suggesting that inappropriate antibiotic treatment is given to approximately 20-25% of patients, potentially prolonging their hospital stay and increasing the risk of morbidity and mortality. The current review paper discusses the concerns related to the management of ABSSSI and the patient types who are most vulnerable to poor outcomes. It also highlights the key management time-points that treating physicians and surgeons must be aware of in order to achieve clinical success and to discharge patients from the hospital as early as possible.

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“…Overall, 21% (22/106) patients with S . aureus ABSSSIs experienced treatment failure [ 20 ]. Treatment failure with disease recurrence is multifactorial including non-adherence to prescribed antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…Lee et al conducted a prospective, observational study among 14 primary care clinics within the South Texas Ambulatory Research Network between 2007 and 2014; the primary outcome was treatment failure within 90 days of the initial visit. Overall, 21% (22/106) patients with S. aureus ABSSSIs experienced treatment failure [20]. Treatment failure with disease recurrence is multifactorial including non-adherence to prescribed antibiotics.…”

Section: Plos Onementioning

confidence: 99%

Improved economic and clinical outcomes with oritavancin versus a comparator group for treatment of acute bacterial skin and skin structure infections in a community hospital

Saddler¹,

Zhang

Sul

et al. 2021

PLoS ONE

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Background Oritavancin is a lipoglycopeptide antibiotic with in vitro bactericidal activity against gram-positive pathogens indicated for use in adults with acute bacterial skin and skin structure infections (ABSSSI). Its concentration-dependent activity and prolonged half-life provide a convenient single-dose alternative to multi-dose daily therapies for ABSSSI. This retrospective cohort study was conducted to quantify the clinical and economic advantages of using oritavancin compared to other antibiotic agents that have been historically effective for ABSSSI. Methods Seventy-nine patients received oritavancin who had failed previous outpatient antibiotic therapy (OPAT) for cellulitis or abscess and were subsequently readmitted to the hospital as an inpatient between 2016 and 2018. These patients were compared to a cohort of 28 patients receiving other antibiotics following OPAT failure and subsequent hospitalization for these two infection types. The primary clinical end point was average length of stay (aLOS) and secondary endpoints included readmission rates for the same indication at 30 and 90 days after discharge and the average hospital cost (aHC). Results A total of 107 patients were hospitalized for treatment of cellulitis or abscess. Demographic characteristics of both the oritavancin and comparator groups were similar except for the presence of diabetes. The primary clinical endpoint showed a non-significant decrease in aLOS between the oritavancin group versus comparator (2.12 days versus 2.59 days; p = 0.097). The secondary endpoints revealed lower readmission rates associated with oritavancin treatment at 30 and 90 days; the average hospital cost was 5.9% lower for patients that received oritavancin. Conclusion The results of this study demonstrate that oritavancin provides not only a single-dose alternative to multi-day therapies for skin and skin structure infections, but also a clinical and economic advantage compared to other antibiotic agents.

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A prospective observational cohort study in primary care practices to identify factors associated with treatment failure in Staphylococcus aureus skin and soft tissue infections

Cited by 9 publications

References 28 publications

The rise of methicillin resistantStaphylococcus aureus: now the dominant cause of skin and soft tissue infection in Central Australia

The rise of methicillin resistantStaphylococcus aureus: now the dominant cause of skin and soft tissue infection in Central Australia

Management of acute bacterial skin and skin structure infections with a focus on patients at high risk of treatment failure

Improved economic and clinical outcomes with oritavancin versus a comparator group for treatment of acute bacterial skin and skin structure infections in a community hospital

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