1848. Evaluation of Antibiotic Prescribing Practices in Outpatient Clinics for the Treatment of Skin & Soft Tissue Infections
Session: Poster Abstract Session: Antimicrobial Stewardship: Outpatient Settings
Saturday, October 6, 2018
Room: S Poster Hall
Background: Ambulatory visits for the treatment of skin and soft tissue infections (SSTIs) have doubled over the past decade and are one of the most common reasons for infection-related visits to outpatient clinics. However, there is limited data evaluating antibiotic prescribing in this population. We aimed to assess the management of SSTIs in adult patients in order to target interventions to improve antibiotic utilization and optimize outcomes.

Methods: This retrospective study included patients within a large academic healthcare system presenting to 38 clinics. Patients were included if they had a diagnosis of a SSTI (ICD-10 for cutaneous abscess, cellulitis, and local SSTIs) in 2016. The primary outcome was to evaluate prescriber compliance to institutional guidelines based on antibiotic selection and duration of therapy. Patient allergies and culture results were used when determining compliance to first-line (trimethoprim-sulfamethoxazole for cutaneous abscess, or cephalexin +/- trimethoprim-sulfamethoxazole for cellulitis and local SSTIs) and second-line recommendations (doxycycline for cutaneous abscess, or clindamycin for cellulitis and local SSTIs). Duration of therapy of 5 to 7 days was considered compliant.

Results: A total of 2,170 adult encounters for the treatment of SSTIs were included; 1,588 with cellulitis, 413 with local infection and 169 with cutaneous abscess. The overall compliance rate for appropriate therapy, including drug selection and duration, was 64.9% (see Figure 1). Unnecessarily long duration of therapy resulted in an extra 1,637 days of antibiotic therapy. Compliance with drug selection occurred more frequently with physicians (40.3%) compared to residents (33.9%) and Advanced Practice Providers (APP) (25.1%).

Conclusion: Compliance with an institutional SSTI guideline for antibiotic selection and duration of therapy is suboptimal in outpatient clinics. Stewardship interventions for SSTIs should target both drug selection and duration, and APPs as an important provider group in outpatient settings.

Figure 1: Compliance stratified by infection type

Infection type

Overall Compliance

Compliance with Drug Selection

Compliance with Duration of Therapy

Cutaneous Abscess

29%

55%

57%

Cellulitis

78%

82%

60%

Local Infection of Skin/Soft Tissue

16%

85%

60%

Bailey Redman, PharmD Candidate, University of Michigan College of Pharmacy, Ann Arbor, MI, Lindsay Petty, MD, Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI and Jerod Nagel, PharmD, BCPS, Department of Pharmacy, Michigan Medicine, Ann Arbor, MI

Disclosures:

B. Redman, None

L. Petty, None

J. Nagel, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.