Skin and soft tissue infections are a commonly encountered medical problem in the hospital setting. Yet, although guidelines have been published to better optimize therapy, many receive broad spectrum antimicrobials. The purpose of this study was to describe antibiotic utilization patterns at our institution, Ochsner Medical Center.
A search was performed using the EPIC (CLARITY) database which included hospital encounters with primary and secondary ICD9 diagnostic codes for skin and soft tissue infections (SSTI), including but not limited to 567.31, 675.## 681.##, 682.##, 683.##, 707.##, 998.59, and 998.83 from January 1 to December 31, 2013. All patients were required to have received antimicrobial therapy in addition to the above codes. Additional inclusion criteria were age 18 or older, and clinical criteria for SSTI. Patients without clinical criteria for SSTI; colonized with bacteria; transferred to another acute care facility; or pregnant were excluded.
A total of 329 unique patients were identified. A preliminary retrospective record review was performed on 94 hospital encounters, yielding 82 unique patients, from January 1 to March 31, 2013. Of those 94 hospital encounters, 56 were excluded. Of the 38 patients included, 47% patients had been on antibiotic therapy during the 10 days prior to admission. Also, 74% were empirically started on broad spectrum antibiotics with piperacillin-tazobactam (PIP-TAZO) and vancomycin (VANC). A total of 17 (45%) patients had positive cultures, 9 (24%) had negative cultures, and 12 (31%) had no cultures performed. Of the 17 patients with positive cultures 88% had empiric PIP-TAZO and VANC with 35% of those appropriately de-escalated at the time of discharge.
Despite easily accessible published guidelines on the management of SSTI, our preliminary data shows that a vast majority of our patients, 74%, received excessive broad spectrum antimicrobials which can lead to adverse outcomes. Of those, less than 50% have positive cultures which may further guide antimicrobial de-escalation. This data will allow us to institute protocols and processes to better improve patient care and minimize exposure to antimicrobials when clinically not indicated.
J. Garcia-Diaz, None
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