1032. Antibiotic Prescribing Practices among Patients Hospitalized with Acute Bacterial Skin and Skin Structure Infection:  Results of a Multi-Center Study
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:   Acute bacterial skin and skin structure infections (ABSSSI) are one of the most common infections resulting in hospitalization.  Although ABSSSI can be treated with short courses of antibiotics targeting Gram-positive bacteria, recent single-center studies showed that antibiotic overuse is common.  The objectives of this study were to evaluate antibiotic prescribing practices for ABSSSI and factors affecting prescribing across a diverse group of hospitals.

Methods:   This was a retrospective cohort study of patients hospitalized for ABSSSI during June 2010 – May 2012 in seven community and academic hospitals.  Up to 85 cases at each site were reviewed and classified as non-purulent cellulitis, purulent cellulitis or wound infection, or major cutaneous abscess.  The primary outcome was a composite of two markers of antibiotic overuse:  1) prescription of antibiotics with broad gram-negative activity, or 2) prolonged treatment duration (>10 days). 

Results: Of 492 eligible patients, 293 had non-purulent cellulitis, 44 had purulent cellulitis or wound infection, and 155 had major abscess.  The median age was 47 years; 102 (21%) were ≤18 years.  Prior skin infection (136, 28%) and diabetes mellitus (92, 19%) were common risk factors.  The predominant site of infection was the lower extremity (296, 60%).  Despite isolation of Gram-negative microorganisms in only 12 (3%) of 385 cases with blood, abscess, or tissue cultures, broad gram-negative antibiotics were prescribed in 44% (range 22-64% across hospitals) and accounted for 39% of the total antibiotic-days prescribed.  Use of broad gram-negative or prolonged therapy occurred in 77% (range 61-95%) of cases and varied significantly across hospitals (p<.001).  By multivariate logistic regression, factors associated with broad gram-negative or prolonged therapy included head or neck involvement (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.1 – 6.5), adult (vs. pediatric) cases (OR 2.2, 95%CI 1.2 – 3.8), and increasing length of hospital stay (OR 1.5 per day, 95%CI 1.2 – 1.7).

Conclusion:   Among patients hospitalized for ABSSSI, antibiotic overuse is widespread.  Given the frequency of ABSSI, interventions to promote shorter courses of therapy targeting Gram-positive pathogens should be an antimicrobial stewardship priority.

Timothy Jenkins, MD1, Brooke Caldwell, MD2, Bruce Mccollister, MD3, S. Jason Moore, PhD, PA4, Sean O'leary, MD, MPH5, Sean Pawlowski, MD6, Daniel Perlman, MD7, Carla Saveli, MD3, Bryan Knepper, MPH, MSc1 and William Burman, MD1, (1)Denver Health Medical Center, Denver, CO, (2)Children's Hospital Colorado, Aurora, CO, (3)University of Colorado, Aurora, CO, (4)Vail Valley Medical Center, Vail, CO, (5)Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, (6)Colorado Infectious Disease Associates, Denver, CO, (7)Porter Adventist Medical Center, Denver, CO

Disclosures:

T. Jenkins, None

B. Caldwell, None

B. Mccollister, None

S. J. Moore, None

S. O'leary, None

S. Pawlowski, None

D. Perlman, None

C. Saveli, None

B. Knepper, None

W. Burman, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.