1626. The Management of Outpatient Cellulitis at The Moncton Hospital before and after the Initiation of a Clinical Treatment Pathway
Session: Poster Abstract Session: Stewardship: Targets for Intervention
Friday, October 6, 2017
Room: Poster Hall CD
  • 1626_IDWPOSTER.pdf (2.0 MB)
  • Background: Antimicrobial Stewardship is a coordinated effort to improve and measure the appropriate use of antimicrobials. Antibiotic resistance is an emerging world health problem and unnecessary prescribing of broad-spectrum antibiotics is a major contributor to this. Skin and soft tissue infections are a common reason to receive a prescription for antibiotics. Currently there exists a trend for using broad-spectrum intravenous antibiotics for moderate to severe infections when more narrow-spectrum options would be adequate. This study aimed to characterize the choice of antibiotic being prescribed for the management of outpatient cellulitis requiring intravenous antibiotics and evaluate the success of a clinical order set outlining optimal therapy.

    Methods: This study was a retrospective chart review looking at antibiotic prescribing through the Emergency Department at The Moncton Hospital, in Moncton, New Brunswick. Charts were reviewed before and after the introduction of a clinical order set outlining optimal antibiotic therapy. The goal was to review charts from the pre- and post-intervention group and compare antibiotic usage, treatment failure rates, and adverse events.

    Results: Of the 54 patients receiving IV antibiotics in the pre-intervention group, 3 received cefazolin, 50 received ceftriaxone, while 1 received levofloxacin. The median duration of IV therapy was four days. After the introduction of the clinical order set there was an absolute increase of 53.8% (n=35) in the use of cefazolin and absolute decrease of 53.7% (n=23) in the use of ceftriaxone in the post-intervention group of 59 patients. Both results were statistically significant (p<0.001). The median duration of IV therapy in this group was 3.5 days. In eligible patients, the clinical order set was utilized 61.1% of the time. There was no significant difference in rates of treatment failure or adverse events between cefazolin and ceftriaxone.

    Conclusion: The introduction of a clinical order set outlining the preferential use of once-daily cefazolin plus probenecid for the treatment of outpatient cellulitis lead to a statistically significant increase use of cefazolin, and decrease use of ceftriaxone, thus demonstrating a positive stewardship effect at a local level.

    Andrew Dalziel, MD1, Daniel Smyth, MD FRCPC2, Ahmed Ghaly, MD FRCPC2, Timothy MacLaggan, BSc Pharm ACPR2 and George Stoica, PhD3, (1)Dalhousie University, Moncton, NB, Canada, (2)Horizon Health Network, Moncton, NB, Canada, (3)Horizon Health Network, Saint John, NB, Canada


    A. Dalziel, None

    D. Smyth, None

    A. Ghaly, None

    T. MacLaggan, None

    G. Stoica, None

    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.