260. Post-discharge antibiotic therapy in patients with acute bacterial skin and skin structure infections
Session: Poster Abstract Session: Clinical: Skin and Soft Tissue
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • IDweek_ARC_05Sep2017.pdf (1014.8 kB)
  • Background: There are limited published data regarding the post-discharge treatment epidemiology for most infections, including acute bacterial skin and skin structure infections (ABSSSIs).

    Methods: This is a national descriptive study of Veterans Affairs medical center admissions with diagnosis codes for ABSSSIs between January 1, 2005 and September 30, 2015. Patients receiving vancomycin during this admission were selected for inclusion. Treatment approaches after hospital discharge, including oral antibiotics, as well as intravenous (IV) medications administered in an outpatient clinic were assessed. Differences between oral and IV groups were assessed with Chi-square or Wilcoxon tests as appropriate.

    Results: Of the 118,135 ABSSSI admissions, 114,352 (96.8%) patients continued antibiotic therapy after discharge. Most patients (98.5%) continued on oral therapy (median length of stay 4 days versus 6 days in IV group; p<0.05). The most common oral therapies after discharge were sulfamethoxazole/trimethoprim (n=30,220, 26.8%) and amoxicillin clavulanate (n=21,819, 19.4%). The most common IV antibiotics were vancomycin (n=740, 57.5%) and ceftriaxone (n=220, 17.1%). Significant differences in demographics and comorbidities were observed between the oral and IV groups, however absolute differences were negligible in some cases (e.g. median age 61 in oral group and 62 in IV group). Cultures were taken in less than half of patients (37.9% oral, 49.7% IV; p<0.05), of which most were Staphylococcus aureus(81.7% oral, 78.4% IV; p<0.05), with higher methicillin resistance in the IV group (59.1% oral, 63.7% IV; p<0.05). In unadjusted comparisons between the oral and IV groups, the following 30-day outcomes differed significantly (p<0.05): emergency room visit (21.6% oral, 45.3% IV), readmission (13.8% oral, 25.5% IV), and reinfection (45.7% oral, 54.3% IV).

    Conclusion: Most patients with ABSSSI admissions continued antibiotic therapy after discharge, with only 1.1% receiving IV antibiotics in an outpatient clinic after discharge. Demographic characteristics and comorbidity burden were similar between the oral and IV groups, however small absolute differences were statistically significant as this was a large cohort.

    Aisling Caffrey, PhD, MS1,2, Maya Beganovic, Pharm.D., MPH1,2, Vrishali Lopes, MS2 and Kerry LaPlante, Pharm.D., FCCP, FIDSA1,3,4, (1)College of Pharmacy, University of Rhode Island, Kingston, RI, (2)Providence Veterans Affairs Medical Center, Providence, RI, (3)Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, (4)Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI

    Disclosures:

    A. Caffrey, Merck: Grant Investigator , Research grant
    The Medicines Company: Grant Investigator , Research grant
    Pfizer: Grant Investigator , Research grant

    M. Beganovic, None

    V. Lopes, None

    K. LaPlante, Merck: Grant Investigator , Grant recipient
    Pfizer: Grant Investigator , Grant recipient
    Cempra: Scientific Advisor , Consulting fee
    The Medicines Company: Grant Investigator , Grant recipient
    Allergan: Scientific Advisor , Consulting fee
    Bard/ Davol: Scientific Advisor , Consulting fee
    Ocean Spray: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient
    Zavante: Scientific Advisor , Consulting fee
    Achaogen: Scientific Advisor , Consulting fee

    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.