LEARNING OBJECTIVE:
- Learners will be able to recognize opportunities to improve antibiotic prescribing for SSTIs in a community hospital emergency department
BACKGROUND/OBJECTIVE: This study aims to characterize and evaluate the appropriateness of antibiotic prescribing for skin and soft tissue infections (SSTI) in patients who are discharged from either Cambridge Health Alliance emergency departments (ED).
METHODS: A retrospective chart review will evaluate adult patients (≥18 years of age) discharged from our institution’s emergency departments with a primary chief complaint of cellulitis or abscess. Exclusion criteria include inpatient admission, concomitant or deep tissue infections, bone and joint infections, infections of the mouth, head, neck, or foot, those involving a bite, surgical site, or underlying hardware, or re-presenting within 72 hours of the index admission for the same infection. Treatment data collected includes incision and drainage and antibiotic agent, dose, and duration. Patients will be categorized by wound purulence and IDSA-defined infection severity (mild, moderate, severe). The primary outcome will be adherence of antibiotic agent, dose, and duration prescribing to 2014 IDSA guidelines. Secondary outcomes include readmission within 30 days of the index ED encounter and documented adverse reaction to antimicrobial therapy.
RESULTS: 200 patients were included in the analysis. Appropriateness was defined as being in compliance with IDSA 2014 guidelines in respect to antibiotic agent, dose, and duration. 32.1% of purulent and 18.8% of nonpurulent infections were prescribed antibiotic regimens in compliance with guideline recommendations. Of these, 56.5% and 71.9% of purulent and nonpurulent infection antibiotics, respectively, were deemed inappropriate due to the duration of therapy. Antibiotic therapy was inappropriate due to broadened coverage in 26.2% and 56.3% of purulent and nonpurulent infections, respectively. In 3.5% and 6.3% of antibiotic regimens, the prescribed dose was below recommended ranges. All cause 30-day readmission was 16.1% and 25% with two documented adverse reactions.
CONCLUSION: It is anticipated that this quality improvement project will provide insight into prescribing practices for SSTIs at our institution’s EDs and opportunities for improvement. Based on these results, the authors plan to propose interventions to the ED which may include additional clinical decision-making support and/or providing departmental education.
SELF ASSESSMENT QUESTION: Which of the following findings is the most appropriate target for an antimicrobial stewardship intervention in adult patients discharged from the ED with SSTIs at our institution?
