Methods: A retrospective observational study evaluating adult patients with a principal ICD-9 diagnosis code of cellulitis or cutaneous abscess was conducted before (between January 1 and December 31, 2011) and after (between April 1, 2013 and March 31, 2014) implementation of the guideline. The primary endpoint was the proportion of uncomplicated SSTIs treated with at least one dose of vancomycin. Secondary endpoints were treatment with broad-spectrum antibiotics, clinical failure, recurrence, and adverse effects.
Results: A total of 259 patients with SSTIs were identified in the pre-intervention group (154 non-purulent and 105 purulent) and 223 patients with SSTIs were identified in the post-intervention group (136 non-purulent and 87 purulent). For non-purulent SSTIs, treatment with vancomycin decreased significantly (92.9% [95%CI 88.8-96.9] v 80.1% [95%CI 73.4-86.9]) and treatment with broad spectrum antibiotics decreased significantly (43.5% [95%CI 35.7-51.3] v 25.7% [95%CI 18.4-33.1]). For patients with purulent SSTIs, vancomycin use did not change (86.7% [95%CI 80.2-93.2] v 87.4% [95%CI 80.4-94.3]) and treatment with broad spectrum antibiotics decreased significantly (46.7% [95%CI 37.1-56.2] v 25.3 [95%CI 16.2-34.4]). There were no differences in rates of treatment failure, recurrence, nephrotoxicity, or infusion related reactions.
Conclusion: Implementation of a clinical practice guideline for the management of hospitalized adults with uncomplicated SSTI can significantly decrease the use of vancomycin for non-purulent infections. In addition, such a guideline can decrease broad-spectrum antibiotic use for the treatment of purulent and non-purulent infections.
A. Knee, Pfizer: Grant Investigator , Educational grant
J. Schimmel, Pfizer: Grant Investigator , Educational grant
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