461. Risk Factors for Inappropriate Initial Empiric Therapy (IET) in Hospitalized Patients with Skin & Soft Tissue Infection (SSTI)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Appropriate IET is critical for optimal clinical & economic outcomes. In the setting of acute hospitalizations for SSTI, factors associated with inappropriate IET are not well understood. We investigated demographic, clinical & laboratory characteristics of SSTI patients as potential risks for inappropriate IET.
Methods: We conducted a retrospective cohort study of patients hospitalized between 12/05 and 10/08. Patients were classified as having HCAI if they were: 1) recently hospitalized; 2) immunocompromised; 3) on hemodialysis; or 4) admitted from nursing home; all others were classified as having CAI. IET was appropriate if antibiotics active against the pathogen(s) were administered within 24 hours of admission. We developed a risk prediction model for inappropriate IET using logistic regression analysis.
Results: Of 264 patients with culture-positive SSTI, 75 (28.4%) received inappropriate IET. Patients without a history of intravenous drug use (IVDU) were more likely to receive inappropriate IET compared to patients with a history of IVDU (OR 2.5, 95% CI 1.0, 5.8). HCAI patients were more likely to receive inappropriate IET compared to CAI patients (OR 2.1, 95% CI 1.2, 3.6). When culture results were added to the model, HCAI status (OR 1.9, 95% CI 1.1, 3.5), pathogens other than Streptococcus species (OR 2.4, 95% CI 1.1, 5.3), & presence of a gram-negative pathogen (OR 2.9 95% CI 1.3, 6.2) were predictive of inappropriate IET.
Conclusion: Both HCAI status & IVDU history were associated with the risk of receiving inappropriate IET. When culture results were considered, HCAI status and the presence of a gram-negative pathogen were predictive of inappropriate IET. Risk factors present at admission may help clinicians determine optimal empiric antibiotic treatment for SSTI.
Supported by a grant from Ortho-McNeil Janssen Scientific Affairs, LLC
Katherine Freeman, DrPH1, Myoung Kim, PhD2, Katherine Miracola, BS3, Lien Vo, PharmD2, Marcos Zervos, PhD3 and  M. Zervos,
Ortho-McNeil Janssen Scientific Affairs, LLC Role(s): Research Relationship, Received: Research Grant.
K. Freeman,
Ortho-McNeil Janssen Scientific Affairs, LLC Role(s): Consultant, Received: Consulting Fee.
L. Vo,
Ortho-McNeil Janssen Scientific Affairs, LLC Role(s): Employee, Received: Salary.
K. Miracola,
Ortho-McNeil Janssen Scientific Affairs, LLC Role(s): Research Relationship, Received: Research Grant.
M. Kim,
Ortho-McNeil Janssen Scientific Affairs, LLC Role(s): Employee, Shareholder (excluding diversified mutual funds), Received: Salary., (1)Albert Einstein College of Medicine, Bronx, NY, (2)Ortho-McNeil Janssen Scientific Affairs, LLC, Raritan, NJ, (3)Henry Ford Health System, Detroit, MI