Compliance to antibiotic guidelines leads to more appropriate use of antibiotics in skin and soft tissue infections in injecting drug users

Abstract

Background Knowledge about treatment of skin and soft tissue infections in injecting drug users in countries with low prevalence of antibiotic resistance is limited. We investigated bacterial antibiotic resistance and treatment of skin and soft tissue infections in Norwegian drug users. Methods We performed a two year clinical cross-sectional observational study in a Norwegian hospital. Data was collected retrospectively from hospital records. We examined bacteriological findings and antibiotic resistance and evaluated compliance to treatment guidelines and appropriateness of empirical antibiotic therapy relative to results of cultures and susceptibility testing. Descriptive and univariate analyses were performed. Results 135 injecting drug users were admitted with skin and soft tissue infection in the study period. Cultures were obtained from 103 (77%) abscesses and eight (24%) erysipelas and cellulitis, with bacterial growth in 80 (78%) and five (63%) respectively. Streptococci and staphylococci were the most prevalent bacteria, but methicillin resistant Staphylococcus aureus was found in only one patient. Compliance to hospital antibiotic guidelines was 70%. 91% of patients in the compliant and 79% in the noncompliant group were given effective empirical antibiotics (p=0,334). In the non-compliant group, significantly more patients received broad-spectrum empirical antibiotics (p<0,001). In 30 cases where adjustment of antibiotic therapy was possible according to susceptibility testing, this was performed in only 14 cases. Conclusions Bacteria and resistance patterns did not differ significantly from skin and soft tissue infections in the general population in Norway. Compliance to antibiotic guidelines led to significantly less use of broad-spectrum antibiotics and to good bacterial coverage. General guidelines for treatment should be applied to injecting drug users with skin and soft tissue infections.

Non-purulent skin and soft tissue infections: predictive power of a severity score and the appropriateness of treatment in a prospective cohort

“…A strikingly high number of different antimicrobial regimes were initiated upon admission, although not as many as detected by Marwick et al [7], again underlining the need for increased adherence to guidelines [9,10]. Furthermore, blood cultures were taken in the vast majority (95%), yet positive cultures were exclusively detected in cases in severity class III or IV.…”

“…To move forward in improving clinical management of SSTIs, and non-purulent SSTIs in particular, the systematic use of severity scores may be one important measure, preferentially implemented as part of facilityspecific care pathways or guidelines, as has been done in Auckland, New Zealand [15]. Standardised care for cellulitis and other SSTIs has been shown to reduce use of both broad-spectrum antibiotics and hospital costs [10,40,41].…”

“…Concerningly, at the severe end of the disease spectrum under-treatment is not uncommon [7,8]. Both over-and under-treatment often represent inadequate adherence to published guidelines [9,10]. This may reflect the lack of a broadly accepted and widely used severity classification system for SSTIs and controversies regarding criteria for hospitalisation and the use of broad-spectrum antibiotics [7,11,12].…”

Drug use evaluation of cefepime at Khartoum North Teaching Hospital in Sudan

“…26,27,29 In contrast, evaluation of antibiotics prescribing in Ghana revealed good adherence to guidelines, while in countries such as Norway antibiotics were always prescribed according to guidelines. 35,36 Our study showed that the majority patients received cefepime for less than 7 days. For better clinical outcomes antibiotics should be given for appropriate duration according to the severity of the disease.…”

“…Inappropriate antibiotic prescribing tends to be a common practice in developing countries including Sudan 26,27,29 . In contrast, evaluation of antibiotics prescribing in Ghana revealed good adherence to guidelines, while in countries such as Norway antibiotics were always prescribed according to guidelines 35,36 …”