Suzanne Lane1, Karissa Johnston2, Katherine A Sulham3, Iqra Syed2, Charles V Pollack4, Thomas Holland5, Dilip Nathwani6. 1. ICON plc Epidemiology, Vancouver, British Columbia, Canada. Electronic address: suzanne.lane@iconplc.com. 2. ICON plc Epidemiology, Vancouver, British Columbia, Canada. 3. The Medicines Company, Waltham, Massachusetts. 4. Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania. 5. Department of Medicine, Duke University Medical Center, Durham, North Carolina. 6. Ninewells Hospital and Medical School, Dundee, United Kingdom.
Abstract
PURPOSE: Rates of acute bacterial skin and skin structure infections (ABSSSI) have sharply increased since 2000. Treatment may be administered in the inpatient or outpatient setting; clinical decision-making regarding hospitalization is inconsistent, often leading to hospitalization of some patients with ABSSSI who qualify for outpatient parenteral antimicrobial therapy, which leads to increased overall care costs. New antibiotics such as oritavancin are hypothesized to be a cost-effective option improving accessibility to ambulatory treatment of ABSSSI. The goal of this study was to understand the patient attributes that affect clinical decision-making regarding the setting of care for ABSSSI treatment. METHODS: An observational, cross-sectional study was conducted that surveyed clinicians of various specialties from the United States and the United Kingdom. The survey collected quantitative responses and used a series of choice-based experimental designs to evaluate patient attributes influencing clinical treatment decisions. FINDINGS: Infection severity, severe comorbidities, and age ≥ 75 years were observed to have the greatest impact on treatment location decisions (odds ratio [OR], 0.000-0.004 [95% CI, 0.000-0.011], vs mild ABSSSI; OR, 0.246-0.484 [95% CI, 0.154-0.788], vs no active comorbidities; OR, 0.136-0.523 [95% CI, 0.070-0.888], vs ≤ 18 years, respectively). The majority of respondents indicated they would consider oritavancin to avoid postdischarge outpatient parenteral antimicrobial therapy or oral therapy, regardless of the pathogen (63.5%-83.5%). IMPLICATIONS: Key factors influencing ABSSSI treatment setting were severity of infection, severity of comorbidities, and age. Clinicians surveyed identified patient profiles in which single-dose oritavancin might enable wholly outpatient or shortened inpatient management. Additional studies to elucidate the ABSSSI care pathways that include oritavancin and other novel antibiotics are needed.
PURPOSE: Rates of acute bacterial skin and skin structure infections (ABSSSI) have sharply increased since 2000. Treatment may be administered in the inpatient or outpatient setting; clinical decision-making regarding hospitalization is inconsistent, often leading to hospitalization of some patients with ABSSSI who qualify for outpatient parenteral antimicrobial therapy, which leads to increased overall care costs. New antibiotics such as oritavancin are hypothesized to be a cost-effective option improving accessibility to ambulatory treatment of ABSSSI. The goal of this study was to understand the patient attributes that affect clinical decision-making regarding the setting of care for ABSSSI treatment. METHODS: An observational, cross-sectional study was conducted that surveyed clinicians of various specialties from the United States and the United Kingdom. The survey collected quantitative responses and used a series of choice-based experimental designs to evaluate patient attributes influencing clinical treatment decisions. FINDINGS: Infection severity, severe comorbidities, and age ≥ 75 years were observed to have the greatest impact on treatment location decisions (odds ratio [OR], 0.000-0.004 [95% CI, 0.000-0.011], vs mild ABSSSI; OR, 0.246-0.484 [95% CI, 0.154-0.788], vs no active comorbidities; OR, 0.136-0.523 [95% CI, 0.070-0.888], vs ≤ 18 years, respectively). The majority of respondents indicated they would consider oritavancin to avoid postdischarge outpatient parenteral antimicrobial therapy or oral therapy, regardless of the pathogen (63.5%-83.5%). IMPLICATIONS: Key factors influencing ABSSSI treatment setting were severity of infection, severity of comorbidities, and age. Clinicians surveyed identified patient profiles in which single-dose oritavancin might enable wholly outpatient or shortened inpatient management. Additional studies to elucidate the ABSSSI care pathways that include oritavancin and other novel antibiotics are needed.
Authors: Safa S Almarzoky Abuhussain; Michelle A Burak; Danyel K Adams; Kelsey N Kohman; Serina B Tart; Athena L V Hobbs; Gabrielle Jacknin; Michael D Nailor; Katelyn R Keyloun; David P Nicolau; Joseph L Kuti Journal: Open Forum Infect Dis Date: 2018-10-08 Impact factor: 3.835
Authors: P Brandon Bookstaver; Timothy C Jenkins; Edward Stenehjem; Shira Doron; Jack Brown; Shannon H Goldwater; Carlos Lopes; Angela Haynes; Chuka Udeze; Yifan Mo; Patrick Gillard; Yan Liu; Katelyn Keyloun Journal: Open Forum Infect Dis Date: 2018-05-15 Impact factor: 3.835
Authors: Safa S Almarzoky Abuhussain; Michelle A Burak; Kelsey N Kohman; Gabrielle Jacknin; Serina B Tart; Athena L V Hobbs; Danyel K Adams; Michael D Nailor; Katelyn R Keyloun; David P Nicolau; Joseph L Kuti Journal: BMC Health Serv Res Date: 2018-12-04 Impact factor: 2.655