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.
S. Almarzoky Abuhussain,
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