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

Published online by Cambridge University Press:  10 May 2016

Timothy C. Jenkins ,
Bryan C. Knepper ,
S. Jason Moore ,
Sean T. O’Leary ,
Brooke Caldwell ,
Carla C. Saveli ,
Sean W. Pawlowski ,
Daniel M. Perlman ,
Bruce D. McCollister  and
William J. Burman
Timothy C. Jenkins*
Affiliation:
Department of Medicine and Division of Infectious Diseases, Denver Health, Denver, Colorado Department of Medicine and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
Bryan C. Knepper
Affiliation:
Department of Patient Safety and Quality, Denver Health, Denver, Colorado
S. Jason Moore
Affiliation:
Department of Trauma and Critical Care Services, Vail Valley Medical Center, Vail, Colorado
Sean T. O’Leary
Affiliation:
Department of Medicine and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado Department of Medicine, Children’s Hospital Colorado, Aurora, Colorado Division of Infectious Diseases, Children’s Hospital Colorado, Aurora, Colorado
Brooke Caldwell
Affiliation:
Department of Medicine, Children’s Hospital Colorado, Aurora, Colorado
Carla C. Saveli
Affiliation:
Department of Medicine and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
Sean W. Pawlowski
Affiliation:
Colorado Infectious Disease Associates, Denver, Colorado
Daniel M. Perlman
Affiliation:
Department of Medicine, Porter Adventist Medical Center, Denver, Colorado
Bruce D. McCollister
Affiliation:
Department of Medicine and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado Department of Medicine and Division of Infectious Diseases, Denver Veterans Affairs Medical Center, Denver, Colorado
William J. Burman
Affiliation:
Department of Medicine and Division of Infectious Diseases, Denver Health, Denver, Colorado Department of Medicine and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado Denver Public Health, Denver Health, Denver, Colorado
*
660 Bannock Street, Denver, CO 80204 ([email protected]).
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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 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.

Infect Control Hosp Epidemiol 2014;35(10):1241–1250

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 10 , October 2014 , pp. 1241 - 1250
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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