Category: Federal Forum Posters
Purpose: Skin and soft tissue infections are the third most common infectious disease causing hospitalization and requiring antibiotic treatment. Nationally, skin and soft tissue infections accounted for 2.5 percent of total hospitalizations from 2007 to 2009 at Veteran Affairs Medical Centers. Failure to use antibacterials properly has numerous health and financial consequences, including adverse drug events, longer antibiotic duration, longer hospital admissions, hospital readmissions, antibiotic resistance, and Clostridium difficile infections. The purpose of this project was to analyze the appropriateness of empiric antibiotic selection and treatment duration for Veterans Affairs Pittsburgh Healthcare System patients with skin and soft tissue infections.
Methods: This evaluation was a single-site retrospective chart evaluation of Veteran Affairs Pittsburgh Healthcare System of seventy-two patient charts from June 1, 2016 and May 31, 2017. Patients must have been age eighteen years or older, received inpatient care, and received systemic antibacterial treatment on greater than two total calendar days initiated within two days after hospital admission. Patients were excluded if they met any of the following criteria: inpatient for skin and soft tissue infection within the past twenty-eight days, systemic antibacterial therapy for non-skin and soft tissue infections indication, inpatient direct transfer from another facility, or severe immunosuppression. Additionally, if the skin and soft tissue infection was related to any of the following, they were excluded: post-operative infection, chronic wounds, involving the face, perirectal or deep tissue infection/involvement. The primary objective was to assess the proportion of veterans hospitalized with skin and soft tissue infections whose empiric antibiotic selection and total duration of antibacterial therapy was in concordance with infectious disease society guidelines. Secondary objectives of this project were describing non-guideline concordant antibacterial use in patients as well as the relative outcomes of need for skin and soft tissue infection treatment, hospital readmission rates, mortality, and Clostridium difficile infection.
Results: Fifty-nine patients had nonpurulent infections, of which twenty-five percent of patients received guideline-concordant therapy. Guideline discordant treatments included the following: thirty-six percent received unnecessary MRSA coverage for a mean duration of 2.9 days (range 1-6 days), two percent had missed or suboptimal streptococci coverage, and fifty-one percent received an unnecessary broad-spectrum antibiotics for mean duration of 2.7 days (range 1-7 days). Thirty-six percent had a treatment duration of greater than ten days. Thirteen patients had purulent infections, of which none of the patients received guideline-concordant therapy. Of these regimens, thirty-one percent missed MRSA coverage and sixty-two percent had unnecessary broad-spectrum Gram-negative coverage with a mean duration of 5.6 days (range 3-11 days). Ninety-two percent had a total duration of greater than ten days. Between the guideline-concordant and guideline-discordant groups, no significant difference was noted in hospital length of stay (p=0.42), skin and soft tissue infection retreatment (p=0.33), or all-cause hospital readmission (p=1.0) within twenty-eight days. There were no Clostridium difficile infections or deaths noted within twenty-eight days of discharge.
Conclusion: Most patients received guideline-discordant therapy for skin and soft tissue infections with no apparent major health related consequences. The results could possibly be explained with the presence of an overall unhealthy patient population. Antimicrobial stewardship has a major opportunity to improve skin and soft tissue infection treatment in a Veteran population.
Rachel Shott– Resident, VA Pittsburgh, Ruffs Dale, PA