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

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 two 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 >10 days. Results 533 cases were included: 320 with non-purulent 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.

Clinical Characteristics and Antibiotic Utilization in Pediatric Patients Hospitalized With Acute Bacterial Skin and Skin Structure Infection

“…9 This suggests that the vast majority of pediatric cases were uncomplicated and responded rapidly to treatment, supporting the assertion that antibiotic use might be safely reduced in this population. A co-management model between primary and Infectious Diseases services may represent one method to optimize antibiotic use and outcomes for ABSSSI, as has been shown with other infectious diseases.…”

“…In addition to the limitations previously outlined, 9 this study has at least four other limitations. First, this is a secondary analysis from a larger cohort study that was not specifically designed to evaluate antibiotic utilization in pediatric cases.…”

Microbiology and Initial Antibiotic Therapy for Injection Drug Users and Non-Injection Drug Users with Cutaneous Abscesses in the Era of Community-associated Methicillin-resistantStaphylococcus aureus

“…5 , 6 The eligibility criteria used to select the two cohorts are summarized in Supplemental Table 1. Briefly, potential cases were identified by International Classification of Diseases, 9 th Revision, Clinical Modification (ICD-9-CM) codes and classified as either cellulitis, wound infection, or cutaneous abscess by manual chart review.…”

Economic Impact of Oritavancin for the Treatment of Acute Bacterial Skin and Skin Structure Infections in the Emergency Department or Observation Setting: Cost Savings Associated with Avoidable Hospitalizations

“…12 We hypothesized that outpatient use of oritavancin in patients with few or no comorbidities and no lifethreatening conditions would be associated with lower costs than inpatient treatment of these patients with vancomycin, the most common standard of care treatment used in this patient population. [13][14][15] To explore this hypothesis, a cost-minimization model was developed from the hospital perspective to estimate the potential cost savings associated with treating adult ABSSSI patients with no or limited comorbidities and no life-threatening conditions with oritavancin in the outpatient setting relative to managing patients in the hospital with intravenous vancomycin. As part of the analysis, we also estimated the threshold for the proportion of patients initially receiving oritavancin in the outpatient setting that could be subsequently admitted while still conferring cost savings associated with oritavancin use relative to inpatient vancomycin therapy.…”