In a recent study, antimicrobial stewardship opportunitites in the treatment of skin and soft tissue infections (SSTIs) were identified. The authors reported that although Staphylococcus and Streptococcus were the only organisms identified in 97% of positive cultures, broad spectrum antibiotics were used in approximately 80% of patients. The most commonly used broad spectrum antibiotic for SSTIs at our institution is ticarcillin/clavulanate.
A prospective cohort of 41 hospitalist patients with cellulitis, cutaneous abscesses, and diabetic ulcers was analyzed from April through June 2011 and compared with a historical control of 42 patients over a similar time frame in 2010. Patients requiring empiric broad spectrum antibiotics (e.g., suspected osteomyelitis, necrotizing fasciitis, severely immunocompromised patients) were excluded from analysis. Several interventions were implemented: provider education at clinical conferences, creation and dissemintation of SSTI guideline pocketcards, and targeted antibiotic monitoring of ticarcillin/clavulanate by floor pharmacists. A second intervention implemented after the study time frame included provider feedback in the form of report cards. Our primary outcome was the time spent on broad spectrum antibiotics relative to the total duration of therapy. Our secondary outcomes included cost of the targeted antibiotic, ticarcillin/cavulanate, length of stay, and 30day readmission rates.
There was a 60% decrease in the proportion of time patients were exposed to broad spectrum antibiotics (0.62 vs 0.25, P= 0.0016). Less patients were empirically treated with 1 or more doses of excessive antibiotics (90% vs 54%, P = 0.0002). The cost of the target antibiotic, ticarcillin/clavulanate, decreased from $3,189.18 in 2010 to $1,767.96. There was no statistically significant change in the length of stay or 30day readmission rate between the two groups.
Implementation of SSTI guidelines via pocket cards combined with targeted antibiotic monitoring successfully decreased excessive antibiotic usage for these infections. Although there was also a decrease in the cost of antibiotics from 2010 to 2011, the goal of this project was to use antibiotics more judiciously when treating SSTIs.
To cite this abstract:Alvarez K, Kolostroubis L, McGarry M, Hoffman P, Kannan S. Antimicrobial Stewardship on the Hospitalist Service: Skin and Soft Tissue Infections. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97598. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/antimicrobial-stewardship-on-the-hospitalist-service-skin-and-soft-tissue-infections/. Accessed May 23, 2019.