Clinical and Economic Consequences of Failure of Initial Antibiotic Therapy for Hospitalized Patients With Complicated Skin and Skin-Structure Infections

Objective.To estimate the consequences of failure of initial antibiotic therapy for patients with complicated skin and skin-structure infections.Design.Retrospective cohort study.Setting.Large US multihospital database.Patients.We identified a total of 47,219 patients (age 18 years or older) who were admitted to the hospital for complicated skin and skin-structure infections from April 1, 2003, through March 31, 2004, and who received intravenous antibiotics during the first 2 hospital-days (ie, initial antibiotic therapy). Failure of therapy was defined as drainage, debridement, or receipt of other intravenous antibiotics at any subsequent time (except for changes to narrower-spectrum agents or any therapy change immediately before discharge). Predictors of failure of antibiotic therapy and mortality were examined using multivariate logistic regression. Analysis of covariance was used to estimate the impact of treatment failure on duration of intravenous antibiotic therapy, length of stay, and total inpatient charges.Results.For 10,782 admitted patients (22.8%), there was evidence of failure of initial antibiotic therapy. In multivariate analyses, treatment failure was associated with receipt of vasoactive medications during the first 2 hospital-days (odds ratio [OR], 1.66 [95% confidence interval {CI}, 1.19-2.31]), initiation of antibiotic therapy in the intensive care unit (OR, 1.53 [95% CI, 1.28-1.84]), and the patient's Charlson comorbidity index (OR per 1-point increase, 1.06 [95% CI, 1.04-1.08]); treatment failure was also was associated with a 3-fold increase in mortality (OR, 2.91 [95% CI, 2.34-3.62]). Compared with patients for whom initial treatment was successful, patients who experienced treatment failure received intravenous antibiotic therapy for a mean of 5.7 additional days, were hospitalized for a mean of 5.4 additional days, and incurred a mean of $5,285 (in 2003 dollars) in additional inpatient charges (all P <.01).Conclusion.Failure of initial antibiotic therapy in the treatment of complicated skin and skin-structure infections is associated with significantly worse clinical and economic outcomes.

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Impact of ambulatory intravenous antibiotic therapy for children with pre-septal cellulitis

Emergency Medicine Journal ◽

10.1136/emj.2010.103150.25 ◽

2010 ◽

Vol 27 (Suppl 1) ◽

pp. A9.2-A9

Author(s):

Rossa Brugha

Keyword(s):

Antibiotic Therapy ◽

Health Economy ◽

Study Group ◽

Intravenous Antibiotic ◽

Preseptal Cellulitis ◽

Intravenous Antibiotic Therapy ◽

Retrospective Audit ◽

Intravenous Antibiotics ◽

Significant Difference ◽

The Impact

AimTo assess the impact of ambulatory intravenous antibiotic therapy for children with preseptal cellulitis.DesignRetrospective audit of 62 patients presenting with preseptal cellulitis over a 12 month period.SettingPaediatric Emergency Department, Chelsea and Westminster Hospital, London.Results62 patients identified from discharge summary coding. On review of medical notes 59 patients fulfilled criteria for preseptal cellulitis. Patients were attributed a modified severity score out of seven, based on signs and symptoms as previously1 19 patients (32%) were discharged home on oral antibiotics, one patient (2%) on topical therapy only, and 39 patients (66%) were started on intravenous antibiotics. There was a significant difference in symptom score between children started on oral versus intravenous antibiotic therapy (2.47 vs 3.21, p=0.021). Of the patients started on intravenous antibiotics, 22 children (56%) were managed on an ambulatory basis and 17 children (44%) were admitted. The management guideline allowed for ambulatory care, provided specified clinical factors were not present. The mean duration of antibiotic therapy was not different between the two groups (2.90 vs 2.75 days, p=0.79). Only three children in the study required imaging and there were no intracranial complications in either group. On a crude cost benefit analysis, the net fiscal benefit of a 3 day course of ambulatory versus inpatient intravenous therapy was calculated as £1672 per patient. For the study group, this represented a saving to the commissioning Trust of £36 784.ConclusionsIn this study group, children requiring intravenous antibiotics for uncomplicated preseptal cellulitis were safely managed on an ambulatory basis. This conveyed a considerable financial benefit to the health economy, in addition to a reduction in the burden of hospitalisation placed upon children and their families.

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PSS7 A PHARMACOECONOMIC APPROACH OF THE USE OF INTRAVENOUS ANTIBIOTIC THERAPY FOR COMPLICATED SKIN AND SKIN-STRUCTURE INFECTIONS IN PUBLIC HEALTH CARE INSTITUTIONS IN MEXICO

Value in Health ◽

10.1016/s1098-3015(10)73439-2 ◽

2009 ◽

Vol 12 (3) ◽

pp. A75-A76 ◽

Cited By ~ 2

Author(s):

IF Soria-Cedillo ◽

VI Baca-Muro ◽

M Martinez-Revelles ◽

J Jirash ◽

T De la Mora-Chávez ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Antibiotic Therapy ◽

Public Health Care ◽

Intravenous Antibiotic ◽

Skin Structure ◽

Intravenous Antibiotic Therapy ◽

Health Care Institutions ◽

Complicated Skin

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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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Patterns of Initial Antibiotic Therapy for Complicated Skin and Skin Structure Infections (cSSSI) in US Hospitals, 2000–2009

Infectious Diseases in Clinical Practice ◽

10.1097/ipc.0b013e318279ee69 ◽

2013 ◽

Vol 21 (3) ◽

pp. 159-167 ◽

Cited By ~ 5

Author(s):

Ariel Berger ◽

John Edelsberg ◽

Gerry Oster ◽

Xingyue Huang ◽

David J. Weber

Keyword(s):

Antibiotic Therapy ◽

Skin Structure ◽

Initial Antibiotic Therapy ◽

Complicated Skin

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A Pathway for Community-Acquired Pneumonia With Rapid Conversion to Oral Therapy Improves Health Care Value

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa497 ◽

2020 ◽

Vol 7 (11) ◽

Author(s):

Claire E Ciarkowski ◽

Tristan T Timbrook ◽

Polina V Kukhareva ◽

Karli M Edholm ◽

Nathan D Hatton ◽

...

Keyword(s):

Antibiotic Therapy ◽

Antimicrobial Stewardship ◽

Academic Medical Center ◽

Community Acquired Pneumonia ◽

Phase 2 ◽

Intravenous Antibiotic ◽

Phase 3 ◽

Baseline Phase ◽

Intravenous Antibiotic Therapy ◽

The Impact

Abstract Background Evidence supports streamlined approaches for inpatients with community-acquired pneumonia (CAP) including early transition to oral antibiotics and shorter therapy. Uptake of these approaches is variable, and the best approaches to local implementation of infection-specific guidelines are unknown. Our objective was to evaluate the impact of a clinical decision support (CDS) tool linked with a clinical pathway on CAP care. Methods This is a retrospective, observational pre–post intervention study of inpatients with pneumonia admitted to a single academic medical center. Interventions were introduced in 3 sequential 6-month phases; Phase 1: education alone; Phase 2: education and a CDS-driven CAP pathway coupled with active antimicrobial stewardship and provider feedback; and Phase 3: education and a CDS-driven CAP pathway without active stewardship. The 12 months preceding the intervention were used as a baseline. Primary outcomes were length of intravenous antibiotic therapy and total length of antibiotic therapy. Clinical, process, and cost outcomes were also measured. Results The study included 1021 visits. Phase 2 was associated with significantly lower length of intravenous and total antibiotic therapy, higher procalcitonin lab utilization, and a 20% cost reduction compared with baseline. Phase 3 was associated with significantly lower length of intravenous antibiotic therapy and higher procalcitonin lab utilization compared with baseline. Conclusions A CDS-driven CAP pathway supplemented by active antimicrobial stewardship review led to the most robust improvements in antibiotic use and decreased costs with similar clinical outcomes.

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