LO52: Predictors of oral antibiotic treatment failure for non-purulent skin and soft tissue infections in the emergency department

Introduction: Current guideline recommendations for optimal management of non-purulent skin and soft tissue infections (SSTIs) are based on expert consensus. There is currently a lack of evidence to guide emergency physicians on when to select oral versus intravenous antibiotic therapy. The primary objective was to identify risk factors associated with oral antibiotic treatment failure. A secondary objective was to describe the epidemiology of adult emergency department (ED) patients with non-purulent SSTIs. Methods: We performed a health records review of adults (age 18 years) with non-purulent SSTIs treated at two tertiary care EDs. Patients were excluded if they had a purulent infection or infected ulcers without surrounding cellulitis. Treatment failure was defined any of the following after a minimum of 48 hours of oral therapy: (i) hospitalization for SSTI; (ii) change in class of oral antibiotic owing to infection progression; or (iii) change to intravenous therapy owing to infection progression. Multivariable logistic regression was used to identify predictors independently associated with the primary outcome of oral antibiotic treatment failure after a minimum of 48 hours of oral therapy. Results: We enrolled 500 patients (mean age 64 years, 279 male (55.8%) and 126 (25.2%) with diabetes) and the hospital admission rate was 29.6%. The majority of patients (70.8%) received at least one intravenous antibiotic dose in the ED. Of 288 patients who had received a minimum of 48 hours of oral antibiotics, there were 85 oral antibiotic treatment failures (29.5%). Tachypnea at triage (odds ratio [OR]=6.31, 95% CI=1.80 to 22.08), chronic ulcers (OR=4.90, 95% CI=1.68 to 14.27), history of MRSA colonization or infection (OR=4.83, 95% CI=1.51 to 15.44), and cellulitis in the past 12 months (OR=2.23, 95% CI=1.01 to 4.96) were independently associated with oral antibiotic treatment failure. Conclusion: This is the first study to evaluate potential predictors of oral antibiotic treatment failure for non-purulent SSTIs in the ED. We observed a high rate of treatment failure and hospitalization. Tachypnea at triage, chronic ulcers, history of MRSA colonization or infection and cellulitis within the past year were independently associated with oral antibiotic treatment failure. Emergency physicians should consider these risk factors when deciding on oral versus intravenous antimicrobial therapy for non-purulent SSTIs being managed as outpatients.

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Predictors of Oral Antibiotic Treatment Failure for Nonpurulent Skin and Soft Tissue Infections in the Emergency Department

Academic Emergency Medicine ◽

10.1111/acem.13492 ◽

2018 ◽

Cited By ~ 2

Author(s):

Krishan Yadav ◽

Kathryn N. Suh ◽

Debra Eagles ◽

John MacIsaac ◽

Darmyn Ritchie ◽

...

Keyword(s):

Emergency Department ◽

Soft Tissue ◽

Treatment Failure ◽

Antibiotic Treatment ◽

Oral Antibiotic ◽

Soft Tissue Infections

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Effectiveness of early switching from intravenous to oral antibiotic therapy in Staphylococcus aureus prosthetic bone and joint or orthopedic metalware-associated infections

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04191-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hélène Boclé ◽

Jean-Philippe Lavigne ◽

Nicolas Cellier ◽

Julien Crouzet ◽

Pascal Kouyoumdjian ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Therapy ◽

Treatment Failure ◽

Cox Model ◽

University Hospital ◽

Empiric Antibiotic Therapy ◽

Oral Antibiotic ◽

Intravenous Antibiotic ◽

Oral Antibiotic Therapy ◽

Intravenous Antibiotic Therapy

Abstract Background The optimal duration of intravenous antibiotic therapy in Staphylococcus aureus prosthetic bone and joint infection has not been established. The objective of this study was to compare the effect of early and late intravenous-to-oral antibiotic switch on treatment failure. Patients and methods We retrospectively analyzed all adult cases of S. aureus prosthetic bone and joint or orthopedic metalware-associated infection between January 2008 and December 2015 in a French university hospital. The primary outcome was treatment failure defined as the recurrence of S. aureus prosthetic bone and joint or orthopedic metalware-associated infection at any time during or after the first line of medical and surgical treatment within 2 years of follow-up. A Cox model was created to assess risk factors for treatment failure. Results Among the 140 patients included, mean age was 60.4 years (SD 20.2), and 66% were male (n = 92). Most infections were due to methicillin-susceptible S. aureus (n = 113, 81%). The mean duration of intravenous antibiotic treatment was 4.1 days (SD 4.6). The majority of patients (119, 85%) had ≤5 days of intravenous therapy. Twelve patients (8.5%) experienced treatment failure. Methicillin-resistant S. aureus infections (HR 11.1; 95% CI 1.5–111.1; p = 0.02), obesity (BMI > 30 kg/m2) (HR 6.9; 95% CI1.4–34.4, p = 0.02) and non-conventional empiric antibiotic therapy (HR 7.1; 95% CI 1.8–25.2; p = 0.005) were significantly associated with treatment failure, whereas duration of intravenous antibiotic therapy (≤ 5 or > 5 days) was not. Conclusion There was a low treatment failure rate in patients with S. aureus prosthetic bone and joint or orthopedic metalware-associated infection with early oral switch from intravenous to oral antibiotic therapy.

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Severity of anaemia and association with all-cause mortality in patients with medically managed left-sided endocarditis

Heart ◽

10.1136/heartjnl-2021-319637 ◽

2021 ◽

pp. heartjnl-2021-319637

Author(s):

Mia Marie Pries-Heje ◽

Rasmus Bo Hasselbalch ◽

Christoffer Wiingaard ◽

Emil Loldrup Fosbøl ◽

Andreas Birkedal Glenthøj ◽

...

Keyword(s):

Antibiotic Treatment ◽

Mortality Rates ◽

Severe Anaemia ◽

Valve Surgery ◽

Oral Antibiotic ◽

Intravenous Antibiotic ◽

All Cause Mortality ◽

Mild Anaemia ◽

Multivariable Adjustment

ObjectiveTo assess the prevalence and severity of anaemia in patients with left-sided infective endocarditis (IE) and association with mortality.MethodsIn the Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis trial, 400 patients with IE were randomised to conventional or partial oral antibiotic treatment after stabilisation of infection, showing non-inferiority. Haemoglobin (Hgb) levels were measured at randomisation. Primary outcomes were all-cause mortality after 6 months and 3 years. Patients who underwent valve surgery were excluded due to competing reasons for anaemia.ResultsOut of 400 patients with IE, 248 (mean age 70.6 years (SD 11.1), 62 women (25.0%)) were medically managed; 37 (14.9%) patients had no anaemia, 139 (56.1%) had mild anaemia (Hgb <8.1 mmol/L in men and Hgb <7.5 mmol/L in women and Hgb ≥6.2 mmol/L) and 72 (29.0%) had moderate to severe anaemia (Hgb <6.2 mmol/L). Mortality rates in patients with no anaemia, mild anaemia and moderate to severe anaemia were 2.7%, 3.6% and 15.3% at 6-month follow-up and 13.5%, 20.1% and 34.7% at 3-year follow-up, respectively. Moderate to severe anaemia was associated with higher mortality after 6 months (HR 4.81, 95% CI 1.78 to 13.0, p=0.002) and after 3 years (HR 2.14, 95% CI 1.27 to 3.60, p=0.004) and remained significant after multivariable adjustment.ConclusionModerate to severe anaemia was present in 29% of patients with medically treated IE after stabilisation of infection and was independently associated with higher mortality within the following 3 years. Further investigations are warranted to determine whether intensified treatment of anaemia in patients with IE might improve outcome.

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Correction: Can We Predict Oral Antibiotic Treatment Failure in Children with Fast-Breathing Pneumonia Managed at the Community Level? A Prospective Cohort Study in Malawi

PLoS ONE ◽

10.1371/journal.pone.0139295 ◽

2015 ◽

Vol 10 (9) ◽

pp. e0139295

Author(s):

Carina King ◽

Eric D. McCollum ◽

Limangeni Mankhambo ◽

Tim Colbourn ◽

James Beard ◽

...

Keyword(s):

Cohort Study ◽

Treatment Failure ◽

Antibiotic Treatment ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Community Level ◽

Oral Antibiotic

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How complicated skin and soft tissue infections are treated in Italy: economic evaluation of inpatient intravenous antibiotic treatment in seven hospitals

Journal of Medical Economics ◽

10.3111/13696990802113196 ◽

2008 ◽

Vol 11 (2) ◽

pp. 265-279 ◽

Cited By ~ 5

Author(s):

Rosanna Tarricone ◽

Giovanni Aguzzi ◽

Alessandro Capone ◽

Carlo Maria Caravaggi ◽

Silvano Esposito ◽

...

Keyword(s):

Economic Evaluation ◽

Soft Tissue ◽

Antibiotic Treatment ◽

Soft Tissue Infections ◽

Intravenous Antibiotic ◽

Complicated Skin

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1454. Cephalosporins and Quinolones Account for 95 Percent of Oral Antibiotic Treatment for Uncomplicated Cystitis in Japan

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1318 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S531-S531

Author(s):

Yoshiki Kusama ◽

Masahiro Ishikane ◽

Tomomi Kihara ◽

Norio Ohmagari

Keyword(s):

Treatment Failure ◽

Antibiotic Treatment ◽

High Morbidity ◽

Oral Antibiotic ◽

Acute Cystitis ◽

New Antibiotics ◽

Antibiotics Use ◽

Fosfomycin Trometamol ◽

Almost All ◽

Uncomplicated Cystitis

Abstract Background Uncomplicated cystitis (UC) imposes a large burden on antimicrobial use due to its high morbidity. IDSA/ESCMID guidelines recommend nitrofurantoin, sulfamethoxazole/trimethoprim (SMX/TMP), fosfomycin trometamol, and pivmecillinam for treating UC, but only SMX/TMP and fosfomycin calcium (FOM-C) are available in Japan. Therefore, we examined the antibiotics use to treat UC in Japan. Methods We obtained data from the JMDC Inc. claims database, which includes data of corporate employees and their family members. We extracted all records of oral antibiotic prescriptions for the treatment of acute cystitis (ICD-10 code: N300) between 2013 and 2016, and excluded prescriptions for male individuals and inpatients because they were considered to have complicated cystitis. Prescriptions for durations >7 days were also excluded because they were potentially prophylactic. Furthermore, we defined treatment failure as cases that required re-prescription within 13 days after the first prescription and estimated the treatment failure rate (TFR) of each antibiotic. Results Cephalosporins and quinolones accounted for 41.5% and 53.2% of the total number of antibiotic prescriptions (48,678). SMX/TMP and FOM-C only accounted for 0.7% and 0.8%. Third-generation cephalosporins accounted for 93.8% of total cephalosporins. TFR was less than 10% across almost all antibiotic categories, with the only exception being FOM-C. Conclusion Cephalosporins and quinolones accounted for 94.7% of oral antibiotic treatment for UC in Japan between 2013 and 2016. To avoid spreading antimicrobial resistance, approval of new antibiotics with good efficacy or an official recommendation for the use of narrower-spectrum antibiotics for treating UC may be required. Disclosures All authors: No reported disclosures.

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The History of Antibiotic Treatment of Osteomyelitis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz181 ◽

2019 ◽

Vol 6 (5) ◽

Cited By ~ 8

Author(s):

Nicolás W Cortés-Penfield ◽

Prathit A Kulkarni

Keyword(s):

Antibiotic Treatment ◽

Limited Data ◽

Quality Of Evidence ◽

Drug Levels ◽

The Past ◽

History Of

AbstractAntibiotic treatment of osteomyelitis has evolved substantially over the past 80 years. Traditional teachings (eg, that antimicrobials must be given parenterally, selected based upon ratios of achieved bone vs serum drug levels, and continued for 4–6 weeks) are supported by limited data. New studies are challenging this dogma, however. In this review, we seek to contextualize the discussion by providing a narrative, chronologic review of osteomyelitis treatment spanning the pre-antibiotic era through the present day and by describing the quality of evidence supporting each component of traditional osteomyelitis therapy.

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Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the emergency department

CJEM ◽

10.1017/cem.2016.347 ◽

2016 ◽

Vol 19 (3) ◽

pp. 175-180 ◽

Cited By ~ 5

Author(s):

Krishan Yadav ◽

Mathieu Gatien ◽

Vicente Corrales-Medina ◽

Ian Stiell

Keyword(s):

Risk Factors ◽

Soft Tissue ◽

Treatment Failure ◽

Perceived Risk ◽

Antimicrobial Treatment ◽

Soft Tissue Infections ◽

Oral Antibiotics ◽

Emergency Physicians ◽

Canadian Association ◽

Patient Reported

AbstractObjectivesWe surveyed Canadian emergency physicians to determine how skin and soft tissue infections (SSTIs) are managed and which risk factors were felt to be important in predicting failure with oral antibiotics.MethodsWe performed an electronic survey of physician members of the Canadian Association of Emergency Physicians (CAEP) using the modified Dillman method.ResultsThe survey response rate was 36.9% (n=391) amongst CAEP members. There was a lack of consensus regarding management of SSTIs. CAEP respondents identified 14 risk factors for predicting treatment failure with oral antibiotics, including hypotension, tachypnea, and patient reported severity of pain >8 of 10.ConclusionsThe survey demonstrates significant variability regarding physician management of SSTIs, and we have identified several perceived risk factors for treatment failure with oral antibiotics that should be assessed in future studies.

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Is there an association between long-term antibiotics for acne and subsequent infection sequelae and antimicrobial resistance? A systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2019-033662 ◽

2020 ◽

Vol 10 (7) ◽

pp. e033662 ◽

Cited By ~ 1

Author(s):

Ketaki Bhate ◽

Liang-Yu Lin ◽

John Barbieri ◽

Clémence Leyrat ◽

Susan Hopkins ◽

...

Keyword(s):

Systematic Review ◽

Antimicrobial Resistance ◽

Treatment Failure ◽

Antibiotic Treatment ◽

Meta Analysis ◽

Cochrane Library ◽

Oral Antibiotic ◽

Oral Antibiotics ◽

The Impact

IntroductionAntimicrobial resistance (AMR) is a global health emergency. Acne vulgaris is a highly prevalent condition and the dominant role antibiotics play in its treatment is a major concern. Antibiotics are widely used in the treatment of acne predominantly for their anti-inflammatory effect, hence their use in acne may not be optimal. Tetracyclines and macrolides are the two most common oral antibiotic classes prescribed, and their average use can extend from a few months to several years of intermittent or continuous use. The overall aim of this systematic review is to elucidate what is known about oral antibiotics for acne contributing to antibiotic treatment failure and AMR.Methods and analysisA systematic review will be conducted to address the question: What is the existing evidence that long-term oral antibiotics used to treat acne in those over 8 years of age contribute towards antibiotic treatment failure or other outcomes suggestive of the impact of AMR? We will search the following databases: Embase, MEDLINE, the Cochrane Library and Web of Science. Search terms will be developed in collaboration with a librarian by identifying keywords from relevant articles and by undertaking pilot searches. Randomised controlled trials, cohort and case-controlled studies conducted in any healthcare setting and published in any language will be included. The searches will be re-run prior to final analyses to capture the recent literature. The Cochrane tool for bias assessment in randomised trials and ROBINS-I for the assessment of bias in non-randomised studies will be used to assess the risk of bias of included studies. GRADE will be used to make an overall assessment of the quality of evidence. A meta-analysis will be undertaken of the outcome measures if the individual studies are sufficiently homogeneous. If a meta-analysis is not possible, a qualitative assessment will be presented as a narrative review.Ethics and disseminationEthical approval is not required for this systematic-review. The results will be published in a peer-reviewed journal and any deviations from the protocol will be clearly documented in the published manuscript of the full systematic-review.PROSPERO registration numberCRD42019121738.

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