Variation by Race in Antibiotics Prescribed for Hospitalized Patients With Skin and Soft Tissue Infections

Abstract

This cohort study examines antibiotics prescribed and variations by race among hospitalized patients with skin and soft tissue infections (SSTIs).

Racial disparities in dermatology

“…A large analysis ( n = 1242) of adult inpatients from 91 US hospitals treated for SSTIs found that cefazolin was more commonly used in White inpatients than in Black inpatients [13% ( n = 114) vs 5% ( n = 11)]; clindamycin was more frequently used in Black inpatients than in White inpatients [12% ( n = 27) vs 7% ( n = 62)]. Adjusting for multiple factors (e.g., methicillin-resistant Staphylococcus aureus colonization, infection, and penicillin allergy), White inpatients were at an increased risk of cefazolin use [aOR, 2.82 (95% CI 1.41–5.63)] and decreased risk of clindamycin use [aOR, 0.54 (95% CI 0.30–0.96)] compared with Black inpatients [ 65 ].…”

Assessment of the representation of black, indigenous and people of colour in dermatology clinical practice guidelines

“…Our findings suggest the existence of gaps in BIPOC‐specific considerations within high‐quality dermatological CPGs. This is of concern as special considerations in these populations and race‐based disparities in prescribing patterns exist across many dermatological conditions, including but not limited to acne and skin and soft tissue infections 7,8 . Possible causes of this paucity in representation include limited research on diverse skin types to inform guideline generation as well as limited numbers of BIPOC individuals included in clinical trials from which guideline recommendations often emerge.…”

“…This is of concern as special considerations in these populations and race-based disparities in prescribing patterns exist across many dermatological conditions, including but not limited to acne and skin and soft tissue infections. 7,8 Possible causes of this paucity in representation include limited research on diverse skin types to inform guideline generation as well as limited numbers of BIPOC individuals included in clinical trials from which guideline recommendations often emerge. It is vitally important for dermatologists to recognize and be familiar with diagnostic and treatment considerations for individuals with skin of colour.…”

Exploring the intersection of racism, antimicrobial resistance, and vaccine equity

“…21 Although antimicrobial regimens for the treatment of CA-MRSA were not described in this study, other investigators have uncovered racial disparities in the management of skin and soft-tissue infections (SSTIs) caused by CA-MRSA. 22 Non-Hispanic Black inpatients were more like to be prescribed clindamycin and not cefazolin therapy (the first-line option) than non-Hispanic White inpatients. 22 This situation is troublesome because clindamycin requires frequent dosing and is associated with Clostridioides difficile infection (CDI) where racial disparities in incidence rates and clinical management have also been described.…”

“…22 Non-Hispanic Black inpatients were more like to be prescribed clindamycin and not cefazolin therapy (the first-line option) than non-Hispanic White inpatients. 22 This situation is troublesome because clindamycin requires frequent dosing and is associated with Clostridioides difficile infection (CDI) where racial disparities in incidence rates and clinical management have also been described. 6,23 Even though data regarding income, SES, and insurance status or type were not collected, they are often factors in decisions regarding treatment selection.…”