696. Variability in Emergency Medicine (EM) Provider Decisions on Hospital Admission and Antibiotic (ABX) Treatment for Acute Bacterial Skin and Skin Structure Infections (ABSSSI)
Session: Poster Abstract Session: Stewardship: Data and Program Planning
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • Provider Survey(DAL17075 5312)_approved poster - 09-26-17.pdf (153.3 kB)
  • Background: ABSSSI are a frequent cause of emergency room visits. Physicians (PHY) and Advanced Practice Providers (APP) have many decisions to make during the initial treatment of ABSSSI, including intravenous (IV) versus oral (PO) ABX, and hospital admission versus discharge home. There are limited data, however, on factors that influence the provider’s decision for the treatment of ABSSSI.

    Methods: An anonymous survey was offered to EM providers at 5 hospitals across the US. The survey presented patient cases with ABSSSI ≥ 75cm2 and escalating clinical scenarios including relapse, controlled diabetes (DM), and SIRS. For each case, participants were queried on their decision for admission versus discharge, ABX therapy (IV, PO, or both), and to rank factors that influenced their ABX decision. Descriptive and inferential statistics were used for analyses.

    Results: Across the 5 hospitals, 104 providers completed the survey; 59 (56.7%) were PHY and 45 (43.3%) were APP. Experience was evenly represented with 50 (48.1%) providers practicing for ≥5 years and 54 (51.9%) less than 5 years. For the first case with no relapse, DM, or SIRS, most providers selected PO ABX [95 (91.4%)] and discharge [100 (96.2%)]. In case 2, the presence of relapse resulted in PO ABX for 50 (48.1%) and discharge in 54 (51.9%) of responses. In case 3, the presence of controlled DM resulted in PO ABX for 55 (53.4%) and discharge home in 65 (63.1%) of responses. Four (3.8%) and 13 (12.5%) providers chose to give 1-2 IV doses followed by PO and discharge the relapsed and DM cases, respectively. Compared with APP, PHY more frequently prescribed PO ABX for the DM case (62.7% versus 40.9%, p=0.046) and incorporated PO ABX into the treatment of the SIRS case (48.3% versus 22.7%, p=0.015). The addition of SIRS criteria in case 4 resulted in initiation with IV ABX [97 (95.1%)] and admission [100 (96.2%)]. The highest ranked factors influencing ABX selection were infection severity and co-morbidities; the lowest were patient convenience, adverse events, and cost.

    Conclusion: These data highlight factors influencing EM provider decisions in the treatment of ABSSSI. Variability in responses to patient cases suggests opportunities for education and the development of an ABSSSI clinical pathway to guide treatment.

    Safa Almarzoky Abuhussain, PharmD1,2, Michelle Krawczynski, PharmD3, Serina Tart, PharmD4, Gabrielle Jacknin, PharmD5, Kelsey Kohman, PharmD6, Athena L. Hobbs, PharmD7, Michael D. Nailor, PharmD, BCPS (AQ-ID)8, Katelyn R. Keyloun, PharmD, MS9, David P. Nicolau, PharmD, FCCP, FIDSA1 and Joseph L. Kuti, PharmD1, (1)Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, (2)Department of Pharmacy, Um-alQura university, Makkah, Saudi Arabia, (3)Hartford Hospital, Hartford, CT, (4)Department of Pharmacy, Cape Fear Valley Health, Fayetteville, NC, (5)Department of Pharmacy, University of Colorado, Aurora, CO, (6)Deparment of Pharmacy, Baylor University Medical Center, Dallas, TX, (7)Department of Pharmacy, Baptist Memorial Hospital, Memphis, TN, (8)University of Connecticut School of Pharmacy, Storrs, CT, (9)Allergan, plc, Irvine, CA

    Disclosures:

    S. Almarzoky Abuhussain, None

    M. Krawczynski, None

    S. Tart, None

    G. Jacknin, None

    K. Kohman, None

    A. L. Hobbs, None

    M. D. Nailor, None

    K. R. Keyloun, Allergan: Employee , Salary

    D. P. Nicolau, Allergan: Grant Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Research grant and Speaker honorarium

    J. L. Kuti, Allergan: Grant Investigator , Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Research grant and Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.