Methods: We performed a retrospective cohort study at the Salt Lake City VA Medical Center including a subset of inpatients between January 1, 2006 and December 30, 2016 with SSTIs based on international classification of diseases (ICD) coding and either HF or obesity. Charts were manually reviewed to collect demographic, comorbidity, severity of illness, microbiology, and treatment data. Patients who were treated with a short course (≤ 8 days) vs a long course (> 8 days) of antimicrobial therapy were evaluated. Primary outcome included treatment failure within 30 days defined as extending therapy, changing or adding antimicrobials, reinitiating therapy or drainage of an abscess after the end of the initial treatment course. Secondary outcomes assessed were length of stay, 30-day readmission, and 30-day mortality.
Results: 466 randomly selected charts were reviewed and 130 patients were included. 128 patients (98%) were male. 32% of patients had HF, 87% obesity and 47% diabetes. 5 patients were admitted to the ICU. Median treatment duration was 12 days [IQR 9-15]. 27 (21%) received ≤ 8 days of antibiotics and 103 (79%) received > 8 days. 5/27 (19%) patients in the short treatment group experienced treatment failure vs 26/103 (25%) in the long treatment group (p=0.466). Median length of stay was 2 days [IQR 2-3] vs 3 days [IQR 2-5] in the short vs long treatment group, respectively (p=0.002). There was no difference in 30-day readmission or 30-day mortality between the two groups.
Conclusion: Commonly prescribed antibiotic durations for SSTIs in patients with obesity and/or HF often exceeded 8 days. Short treatment duration does not appear to be associated with treatment failure, highlighting an opportunity for antimicrobial stewardship intervention.
T. T. Timbrook, None
E. Spivak, None