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 2 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 greater than 10 days. RESULTS: A total of 533 cases were included: 320 with nonpurulent 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.
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 2 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 greater than 10 days. RESULTS: A total of 533 cases were included: 320 with nonpurulent 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.
Authors: Catherine Liu; Arnold Bayer; Sara E Cosgrove; Robert S Daum; Scott K Fridkin; Rachel J Gorwitz; Sheldon L Kaplan; Adolf W Karchmer; Donald P Levine; Barbara E Murray; Michael J Rybak; David A Talan; Henry F Chambers Journal: Clin Infect Dis Date: 2011-02-01 Impact factor: 9.079
Authors: J Carratalà; B Rosón; N Fernández-Sabé; E Shaw; O del Rio; A Rivera; F Gudiol Journal: Eur J Clin Microbiol Infect Dis Date: 2003-03-05 Impact factor: 3.267
Authors: Benjamin A Lipsky; John A Weigelt; Vikas Gupta; Aaron Killian; Michael M Peng Journal: Infect Control Hosp Epidemiol Date: 2007-10-03 Impact factor: 3.254
Authors: Norihiro Yogo; Katherine Shihadeh; Heather Young; Susan L Calcaterra; Bryan C Knepper; William J Burman; Philip S Mehler; Timothy C Jenkins Journal: Infect Control Hosp Epidemiol Date: 2017-03-06 Impact factor: 3.254
Authors: Laveta Stewart; Ping Li; Maj Dana M Blyth; Wesley R Campbell; Joseph L Petfield; Margot Krauss; Lauren Greenberg; David R Tribble Journal: Mil Med Date: 2020-01-07 Impact factor: 1.437
Authors: Timothy C Jenkins; Bryan C Knepper; S Jason Moore; Carla C Saveli; Sean W Pawlowski; Daniel M Perlman; Bruce D McCollister; William J Burman Journal: J Hosp Med Date: 2014-09-30 Impact factor: 2.960
Authors: Timothy C Jenkins; Bryan C Knepper; S Jason Moore; Carla C Saveli; Sean W Pawlowski; Daniel M Perlman; Bruce D McCollister; William J Burman Journal: Acad Emerg Med Date: 2015-07-22 Impact factor: 3.451
Authors: Timothy C Jenkins; Bryan C Knepper; Bruce D McCollister; S Jason Moore; Sean W Pawlowski; Daniel M Perlman; Carla C Saveli; Sean T O'Leary; William J Burman Journal: Am J Emerg Med Date: 2016-02-12 Impact factor: 2.469
Authors: Jesse D Sutton; Ronald Carico; Muriel Burk; Makoto M Jones; XiangMing Wei; Melinda M Neuhauser; Matthew Bidwell Goetz; Kelly L Echevarria; Emily S Spivak; Francesca E Cunningham Journal: Open Forum Infect Dis Date: 2020-01-27 Impact factor: 3.835