Abstract
BackgroundSkin and soft tissue infections (SSTIs) are a leading cause for hospitalizations in the United States. Few studies have addressed the appropriateness of antibiotic therapy in the management of SSTIs without complicating factors. We aimed to determine the appropriateness of antibiotic treatment duration for hospitalized adult patients with uncomplicated SSTIs.MethodsThis was a retrospective analysis performed at two academic medical centers in Pittsburgh, Pennsylvania on patients aged 18 years and older with primary ICD-9 code for SSTIs admitted August 1st, 2014–March 31st, 2015. The primary outcome was the appropriateness of antibiotic treatment duration for uncomplicated SSTIs. Secondary objectives included the appropriateness of antibiotic agent spectrum, duration of inpatient length of stay (LOS), utilization of blood cultures and advanced imaging modalities, and re-hospitalization for SSTI within 30 days of discharge from the index admission.ResultsA total of 163 episodes were included in the cohort. The mean duration of total antibiotic therapy was 12.6 days. Appropriate duration was defined as receipt of total antibiotic duration of less than 10 days and occurred in 20.2% of patients. Twenty eight percent of patients received antibiotics for greater than 14 days. Seventy three (44.8%) patients received greater than 24 h of inappropriate extended spectrum gram-negative coverage; 65 (39.9%) received anaerobic coverage.ConclusionsIn the majority of patients, treatment duration was excessive. Inappropriate broad spectrum antibiotic selection was utilized with regularity for SSTIs without complicating factors. The management of uncomplicated SSTIs represents a significant opportunity for antimicrobial stewardship.
Highlights
Skin and soft tissue infections (SSTIs) are a leading cause for hospitalizations in the United States
Study design We identified patients discharged from Allegheny General Hospital (AGH) and Western Pennsylvania Hospital (WPH) from August 1st, 2014 through March 31st, 2015 with a primary diagnosis of SSTI using International Classification of Diseases, Ninth Revision (ICD-9), coding data
Secondary objectives included the appropriateness of antibiotic agent spectrum of coverage, the duration of inpatient length of stay (LOS), utilization of blood cultures and advanced imaging techniques via computed tomography (CT) scan or magnetic resonance imaging (MRI), and re-hospitalization for SSTI to AGH or WPH within 30 days of discharge from the index admission
Summary
Skin and soft tissue infections (SSTIs) are a leading cause for hospitalizations in the United States. We aimed to determine the appropriateness of antibiotic treatment duration for hospitalized adult patients with uncomplicated SSTIs. Skin and soft tissue infections (SSTIs) are the second most common type of infections leading to hospitalization in the United States and are becoming increasingly more prevalent [1, 2]. Further studies evaluating the details of antibiotic agent spectrum and duration of therapy for SSTIs without complicating factors are needed in order to properly develop targeted initiatives in order to optimize antibiotic utilization for this disease state
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