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Sutton JD, Carico R, Burk M, et al. Inpatient Management of Uncomplicated Skin and Soft Tissue Infections in 34 Veterans Affairs Medical Centers: A Medication Use Evaluation. Open Forum Infect Dis. 2020;7(1):ofz554doi: 10.1093/ofid/ofz554.
Sutton, J. D., Carico, R., Burk, M., Jones, M. M., Wei, X., Neuhauser, M. M., Goetz, M. B., Echevarria, K. L., Spivak, E. S., Cunningham, F. E. (2020). Inpatient Management of Uncomplicated Skin and Soft Tissue Infections in 34 Veterans Affairs Medical Centers: A Medication Use Evaluation. Open forum infectious diseases, 7(1), ofz554. https://doi.org/10.1093/ofid/ofz554
Sutton, Jesse D, et al. "Inpatient Management of Uncomplicated Skin and Soft Tissue Infections in 34 Veterans Affairs Medical Centers: A Medication Use Evaluation." Open forum infectious diseases vol. 7,1 (2020): ofz554. doi: https://doi.org/10.1093/ofid/ofz554
Sutton JD, Carico R, Burk M, Jones MM, Wei X, Neuhauser MM, Goetz MB, Echevarria KL, Spivak ES, Cunningham FE. Inpatient Management of Uncomplicated Skin and Soft Tissue Infections in 34 Veterans Affairs Medical Centers: A Medication Use Evaluation. Open Forum Infect Dis. 2020 Jan 27;7(1):ofz554. doi: 10.1093/ofid/ofz554. eCollection 2020 Jan. PMID: 32010738; PMCID: PMC6984672.
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Open Forum Infect Dis. 2020 Jan 27;7(1):ofz554. doi: 10.1093/ofid/ofz554. eCollection 2020 Jan.

Inpatient Management of Uncomplicated Skin and Soft Tissue Infections in 34 Veterans Affairs Medical Centers: A Medication Use Evaluation.

Open forum infectious diseases

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,

Affiliations

  1. Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA.
  2. VA Salt Lake City Informatics Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Salt Lake City, Utah, USA.
  3. Center for Medication Safety, Hines VA, Hines, Illinois, USA.
  4. VA Pharmacy Benefits Management Services, Hines VA, Hines, Illinois, USA.
  5. Department of Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
  6. Veterans Affairs Greater Lost Angeles Healthcare System, Los Angeles, California, USA.
  7. David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.
  8. Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA.

PMID: 32010738 PMCID: PMC6984672 DOI: 10.1093/ofid/ofz554

Abstract

BACKGROUND: Skin and soft tissue infections (SSTIs) are a key antimicrobial stewardship target because they are a common infection in hospitalized patients, and non-guideline-concordant antibiotic use is frequent. To inform antimicrobial stewardship interventions, we evaluated the proportion of veterans hospitalized with SSTIs who received guideline-concordant empiric antibiotics or an appropriate total duration of antibiotics.

METHODS: A retrospective medication use evaluation was performed in 34 Veterans Affairs Medical Centers between 2016 and 2017. Hospitalized patients who received antibiotics for uncomplicated SSTI were included. Exclusion criteria were complicated SSTI, severe immunosuppression, and antibiotics for any non-SSTI indication. Data were collected by manual chart review. The primary outcome was the proportion of patients receiving both guideline-concordant empiric antibiotics and appropriate treatment duration, defined as 5-10 days of antibiotics. Data were analyzed and reported using descriptive statistics.

RESULTS: Of the 3890 patients manually evaluated for inclusion, 1828 patients met inclusion criteria. There were 1299 nonpurulent (71%) and 529 purulent SSTIs (29%). Overall, 250 patients (14%) received guideline-concordant empiric therapy and an appropriate duration. The most common reason for non-guideline-concordance was receipt of antibiotics targeting methicillin-resistant

CONCLUSIONS: We identified 3 common opportunities to improve antibiotic use for patients hospitalized with uncomplicated SSTIs: use of anti-MRSA antibiotics in patients with nonpurulent SSTIs, use of broad-spectrum Gram-negative antibiotics, and prolonged durations of therapy.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2020.

Keywords: abscess; antibiotic stewardship; cellulitis; skin and soft tissue infections

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