997. Compliance with Institutional Skin and Soft Tissue Infection Guidelines and Associated Outcomes
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Background: IDSA guidelines recommend multiple treatment options for skin and soft tissue infections (SSTIs). Institutional guidelines were developed to stratify therapy with the goal of minimizing use of unnecessary broad-spectrum antibiotics and antibiotics that increase risk for C.difficile infection (CDI). There is minimal published data evaluating compliance with institutional guidelines and the impact on outcomes.

Methods: This retrospective, single-center, cohort study evaluated treatment regimens for inpatients with SSTIs and associated outcomes. Patients included were hospitalized between July 2012-July 2013 with an ICD9 associated with SSTIs. Patients were stratified into 2 groups: compliant and non-compliant based institutional SSTI guidelines and the initial antibiotic therapy in the Emergency Department. Outcomes evaluated include 30-day readmission rate, length of stay (LOS), failure of initial therapy, mortality and incidence of CDI.

Results: 259 patients were included in the study: 128 (49%) with non-purulent cellulitis, 11 (4%) with purulent cellulitis without abscess, 35 (14%) with purulent cellulitis with simple abscess, and 72 (28%) with complicated SSTI. Treatment was compliant with guidelines for 62 (26.4%) patients and the most common reason for non-compliance was clindamycin use for uncomplicated SSTIs. Compliance with guidelines did not demonstrate significant differences in LOS (3.3 vs. 3.4 days, p=0.853), mortality (3.2 vs. 0%, p=0.069), readmission (14.5 vs. 9.8%, p=0.347), or failure of initial therapy requiring antibiotic escalation (11.3 vs. 13.9%, p=0.669). Non-compliance with institutional guidelines demonstrated a 2.875 increased relative risk for CDI, but the incidence was not statistically significant (1.6 vs. 4.6%, p=0.351).

Conclusion: Compliance with institutional guidelines was low, and the most common reason for non-compliance was clindamycin use as first-line therapy for uncomplicated SSTIs. However, clinical outcomes were not different between groups. Larger studies are needed to determine if compliance is associated with lower incidence of CDI.

Jared Borlagdan, Pharmacy student, University of Michigan College of Pharmacy, Ann Arbor, MI, Carol Chenoweth, MD, MS, FSHEA, FIDSA, Internal Medicine-Infectious Diseases, University of Michigan Health System, Ann Arbor, MI, Tejal Gandhi, MD, Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI and Jerod Nagel, PharmD, University of Michigan Health System, Ann Arbor, MI

Disclosures:

J. Borlagdan, None

C. Chenoweth, None

T. Gandhi, None

J. Nagel, None

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