288. Patterns of Initial Antibiotic Therapy in Hospitalized Patients with Complicated Skin and Skin Structure Infections (cSSSI) in the US: 2007-2010
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1

Background:  Initial antibiotic treatment of cSSSIs is often empiric, and is based on presumed source of infection, probable pathogens, patient characteristics, and treatment guidelines.  Current “real world” patterns of initial therapy in cSSSI have not been well-documented.

Methods:  Using a database with information from >100 hospitals, we identified all admissions between 1/1/2007 and 6/30/2010 of persons aged ≥18y with ICD-9-CM diagnoses of skin infection (e.g., cellulitis, decubitus ulcer, postoperative wound infection). We constituted 3 cohorts, based on presumed infection source (community-acquired [CA], healthcare-associated [HCA], nosocomial [N]). For each admission, we ascertained time when antibiotic treatment for cSSSI began, and characterized initial antibiotic therapy based on all parenteral agents received within the next 36hr. Patterns of initial antibiotic therapy were examined by cohort, including use of agents with activity against methicillin-resistant S. aureus (MRSA).

Results:  A total of 16,444 admissions satisfied all entry criteria:  70% (n=11,513) were CA, 11% (n=1873) were HCA, and 19% (n=3058) were N.  More than one-half of all patients (CA, 68%; HCA, 66%; N, 54%) received initial therapies providing coverage against MRSA (either monotherapy or as part of a multi-drug regimen). The majority of patients were treated initially with vancomycin (CA, 57%; HCA, 57%; N, 46%), followed by clindamycin (14%, 8%, and 5%, respectively), daptomycin (2%, 3%, 3%), and linezolid (2%, 3%, 2%).  Use of agents providing coverage for MRSA increased between 2007 and 2010 by about 20% in CA (from 61% to 73%) (p<0.01); no such increase was noted in either HCA (from 61% to 63%) or N (from 53% to 52%) (Figure).

Conclusion: Use of agents providing coverage for MRSA, predominantly vancomycin, has continued to increase in cSSSI, especially among in patients with CA infections. 


Figure. Use of antibiotics providing coverage against MRSA as initial therapy, by year and cohort*

 

*All values are percent of patients

**January 1, 2010 – June 30, 2010 only

NOTE: Patients may have received multiple agents; values may not sum to total


Subject Category: A. Antimicrobial agents and Resistance

Ariel Berger, MPH1, Amanda J Boening, PharmD2, Peggy McKinnon, PharmD2, Gerry Oster, Ph.D.1 and David Weber, MD, MPH, FIDSA3, (1)Policy Analysis Inc., Brookline, MA, (2)Cubist Pharmaceuticals, Lexington, MA, (3)University of North Carolina, School of Medicine, Chapel Hill, NC

Disclosures:

A. Berger, Forest Research Institute: Research Contractor, Research grant
Pfizer: Research Contractor, Research support
Cubist: Research Contractor, Research grant

A. J. Boening, Cubist: Employee and Shareholder, Salary

P. McKinnon, Cubist: Employee and Shareholder, Salary

G. Oster, Forest Research Institute: Research Contractor, Research grant
Pfizer: Research Contractor, Research grant
Cubist: Research Contractor, Research grant

D. Weber, Cubist: Collaborator, Consultant, Research Contractor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
Merck: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
GSK: Scientific Advisor, Consulting fee and Speaker honorarium
Pfizer: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
Ortho: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
Sanofi: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.