Methods: We enrolled adult patients hospitalized with uncomplicated SSTIs caused by S. aureus at an academic medical center to measure adherence, determine factors associated with adherence to post-discharge antibiotic therapy, and describe the relationship between adherence and clinical outcomes. We fitted consenting subjects’ pill bottle with a medication event monitoring system (MEMS) cap, which electronically records each time the patient opens their pill bottle. We administered an in-person standardized questionnaire at enrollment, 14 days, and 30 days to all subjects and reviewed of each subjects’ medical records to determine outcomes. Poor clinical response was defined as receipt of new antibiotics, new incision and drainage procedure, or a new skin infection within 30 days of hospital discharge.
Results: We enrolled 188 subjects, of which 87 had complete data available for analysis. Among these subjects, 40 (46%) had a poor clinical response to antibiotic therapy within 30 days after their initial infection. The average adherence to antibiotic therapy measured by MEMS was significantly different than adherence reported by subjects (57% vs. 96%, p<0.0001). Factors associated with lower adherence included: receiving > 1 antibiotic after discharge, patient report of never seeing the same provider, or feel that they did not have a regular healthcare provider (p<0.05). In a multivariable logistic regression model, poor clinical response at 30 days was associated with lower adherence, being non-diabetic, and lack of illicit drug use (p<0.05).
Conclusion: In our study, patient adherence to antibiotic therapy was low (57%) and associated with poor clinical outcome. Patients typically overstate their medication adherence, which may make identifying patients at risk for non-adherence and poor outcomes challenging. Further studies are needed to determine methods to improve post-discharge antibiotic adherence after an SSTI.
S. J. Eells,
J. Jung, None
R. Macias-Gil, None
L. May, None
L. Miller, Merck and Co., Inc.: Consultant , Consulting fee
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