scholarly journals Relationship between Adherence to Oral Antibiotics and Postdischarge Clinical Outcomes among Patients Hospitalized with Staphylococcus aureus Skin Infections

2016 ◽  
Vol 60 (5) ◽  
pp. 2941-2948 ◽  
Author(s):  
Samantha J. Eells ◽  
Megan Nguyen ◽  
Jina Jung ◽  
Raul Macias-Gil ◽  
Larissa May ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Clinical Response ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Oral Antibiotic ◽  
Soft Tissue Infections ◽  
Oral Antibiotics ◽  
Oral Antibiotic Therapy

ABSTRACTSkin and soft tissue infections are common and frequently recur. Poor adherence to antibiotic therapy may lead to suboptimal clinical outcomes. However, adherence to oral antibiotic therapy for skin and soft tissue infections and its relationship to clinical outcomes have not been examined. We enrolled adult patients hospitalized with uncomplicated skin and soft tissue infections caused byStaphylococcus aureuswho were being discharged with oral antibiotics to complete therapy. We fit the participants' pill bottles with an electronic bottle cap that recorded each pill bottle opening, administered an in-person standardized questionnaire at enrollment, 14 days, and 30 days, and reviewed the participants' medical records to determine outcomes. Our primary outcome was poor clinical response, defined as a change in antibiotic therapy, new incision-and-drainage procedure, or new skin infection within 30 days of hospital discharge. Of our 188 participants, 87 had complete data available for analysis. Among these participants, 40 (46%) had a poor clinical response at 30 days. The mean electronically measured adherence to antibiotic therapy was significantly different than the self-reported adherence (57% versus 96%;P< 0.0001). In a multivariable model, poor clinical response at 30 days was associated with patients having lower adherence, being nondiabetic, and reporting a lack of illicit drug use within the previous 12 months (P< 0.05). In conclusion, we found that patient adherence to oral antibiotic therapy for a skin and soft tissue infection after hospital discharge was low (57%) and associated with poor clinical outcome. Patients commonly overstate their medication adherence, which may make identification of patients at risk for nonadherence and poor outcomes challenging. Further studies are needed to improve postdischarge antibiotic adherence after skin and soft tissue infections.

scholarly journals 289. Impact of Clinician Specialty on the Use of Oral Antibiotic Therapy for Definitive Treatment of Uncomplicated Bloodstream Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S145
Author(s):  
Jasmine R Marcelin ◽  
Mackenzie R Keintz ◽  
Jihyun Ma ◽  
Erica J Stohs ◽  
Bryan Alexander ◽  
...  
Keyword(s):  
Social Media ◽  
Soft Tissue ◽  
Infectious Diseases ◽  
Antibiotic Therapy ◽  
Bloodstream Infections ◽  
Definitive Treatment ◽  
Oral Antibiotic ◽  
Soft Tissue Infections ◽  
Gram Positive ◽  
Oral Antibiotic Therapy

Abstract Background No established guidelines exist regarding the role of oral antibiotic therapy (OAT) to treat uncomplicated bloodstream infections (uBSIs) and practices may vary depending on clinician specialty and experience. Methods An IRB-exempt web-based survey was emailed to Nebraska Medicine clinicians caring for hospitalized patients, and widely disseminated using social media. The survey was open access and once disseminated on social media, it was impossible to ascertain the total number of individuals who received the survey. Chi-squared analysis for categorical data was conducted to evaluate the association between responses and demographic groups. Results Of 275 survey responses, 51% were via social media, and 94% originated in the United States. Two-thirds of respondents were physicians, 16% pharmacists, and infectious diseases clinicians (IDC) represented 71% of respondents. The syndromes where most were comfortable using OAT routinely for uBSI were urinary tract infection (92%), pneumonia (82%), pyelonephritis (82%), and skin/soft tissue infections (69%). IDC were more comfortable routinely using OAT to treat uBSIs associated with vertebral osteomyelitis and prosthetic joint infections than non-infectious diseases clinicians (NIDC), but NIDC were more likely to report comfort with routine use of OAT to treat uBSIs associated with meningitis and skin/soft tissue infections. IDC were more likely to report comfort with routine use of OAT for uBSIs due to Enterobacteriaceae and gram-positive anaerobes, while NIDC were more likely to be comfortable with routinely using OAT to treat uBSIs associated with S. aureus, coagulase-negative staphylococci and gram-positive bacilli. In one clinical vignette of S. aureus uBSI due to debrided abscess, 11% of IDC would be comfortable using OAT vs 28% of NIDC; IDC were more likely to report routinely repeating blood cultures (99% vs 83%, p&lt; 0.05). Figure 1: Clinician comfort using oral antibiotic therapy to treat uncomplicated bacteremia due to specific syndromes Figure 2: Clinician comfort using oral antibiotic therapy to treat uncomplicated bacteremia due to specific organisms Conclusion Considerable variation in comfort using OAT for uBSIs among IDC vs NIDC exists, highlighting opportunities for IDC to continue to demonstrate their value in clinical practice. Understanding the reasons for variability may be helpful in creating best practice guidelines to standardize decision making. Disclosures All Authors: No reported disclosures

Comparison between vinegar wash and culture based oral antibiotic therapy in active chronic suppurative otitis media

2017 ◽  
Vol 3 (2) ◽  
pp. 204
Author(s):  
Supreetha B. Shenoy ◽  
Raveendra P. Gadag ◽  
Somanath B. Megalamani ◽  
Annapurna S. Mushannavar
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Therapy ◽  
Otitis Media ◽  
Chronic Suppurative Otitis Media ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Suppurative Otitis Media ◽  
Oral Antibiotic Therapy ◽  
Significant Difference ◽  
Sensitivity Report

<p class="abstract"><strong>Background:</strong> Chronic otorrhea in chronic suppurative otitis media (CSOM) has become a difficult task to treat for ENT specialists because of emerging resistance to the available antibiotics and patient’s affordability for its cost. Also biofilms have been responsible for the chronicity of disease. Use of vinegar as an antiseptic and altering the pH of middle ear to treat otorrhea in CSOM needs to be studied<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> 120 patients with active CSOM were recruited randomly for either vinegar wash or antibiotic therapy. Vinegar diluted with water in 1:1 ratio at pH 4 was used twice a day for 3weeks to one group. Oral antibiotics based on culture sensitivity report were given to other group for 3weeks. Both groups were followed up for a month and observed for resolution of ear discharge<span lang="EN-IN">.  </span></p><p class="abstract"><strong>Results:</strong> <em>Pseudomonas </em>(40%) and <em>Staphylococcus aureus</em> (25%) were the most common organisms detected. 96.2% of <em>Pseudomonas</em> and 50% of <em>Staphylococcus aureus</em> ears became dry with vinegar wash. 81.67% of antibiotic group and 68.33% of vinegar group ears became dry in 3weeks. No statistically significant difference between vinegar wash and culture based oral antibiotic therapy in resolution of ear discharge was seen in active CSOM (p &gt;0.05)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Management of otorrhea is long term in CSOM and vinegar can be used as an alternative to costly oral antibiotics for resolution of ear discharge in active CSOM. Two fold dilution of vinegar prevents chance of ototoxicity<span lang="EN-IN">.</span></p>

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

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.

scholarly journals Vancomycin Area Under the Curve to Predict Timely Clinical Response in the Treatment of Methicillin-resistant Staphylococcus aureus Complicated Skin and Soft Tissue Infections

2020 ◽  
Author(s):  
Sara Alosaimy ◽  
Kyle P Murray ◽  
Evan J Zasowski ◽  
Taylor Morrisette ◽  
Abdalhamid M Lagnf ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Area Under The Curve ◽  
Soft Tissue Infections ◽  
Methicillin Resistant ◽  
Cart Analysis ◽  
Complicated Skin

Abstract Introduction Although recent guidelines have recommended monitoring vancomycin (VAN) area under the curve (AUC)/minimum inhibitory concentration (MIC) to ensure clinical efficacy and minimize toxicity in methicillin-resistant Staphylococcus aureus (MRSA) for various infections, there are no recommendations regarding complicated skin and soft tissue infections (cSSTIs). We aimed to evaluate the association between VAN AUC and clinical outcomes in MRSA cSSTIs. Methods This was a retrospective cohort study of adult patients treated with ≥ 72 hours of VAN for MRSA cSSTI from 2008-2013 at Detroit Medical Center. The primary outcome was timely clinical success (TCS) defined as 1) resolution of signs and symptoms of infection within 72 hours, 2) stabilization and/or reduction in lesion size, 3) alternative agents not required due to VAN failure or toxicity as elected by the prescribing clinician. Classification and regression tree (CART) analysis was performed to determine the AUC associated with TCS in the cohort. Multivariable logistic regression was used to evaluate the association between VAN-AUC and the primary outcome. Results A total of 154 patients were included in this analysis. CART identifed an AUC ≥435 mg*hr/L for TCS. Overall, 60.9% of patients experienced TCS; 69.7% in the target-AUC group vs. 52.5% in the below-target AUC group, (P=0.013). Target-AUC attainment was independently associated with increased odds of TCS ([aOR], 2.208; 95% [CI], 1.047 -4.659). Discussion In adults treated with VAN for MRSA cSSTI, target-AUC attainment was independently associated with improved clinical outcomes and maybe most warrated for patients at high risk of VAN-failure or VAN-associated toxicity.

Oral Antibiotic Therapy of Skeletal Infections in Children

PEDIATRICS ◽  
1980 ◽  
Vol 65 (5) ◽  
pp. 867-871 ◽  
Author(s):  
E. Kolyvas ◽  
G. Ahronheim ◽  
M. I. Marks ◽  
R. Gledhill ◽  
H. Owen ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Prospective Study ◽  
Oral Therapy ◽  
Clinical Course ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Oral Antibiotic Therapy ◽  
Erythrocyte Sedimentation

Oral and intravenous (IV) antibiotic regimens were compared in 15 children with etiologically defined osteomyelitis and/or septic arthritis. On admission all children were started on standard IV therapy; seven were changed to oral antibiotics within 72 hours and the remaining eight continued on IV therapy for four weeks. Oral antibiotic doses were adjusted to achieve a peak serum bactericidal titer of [unknown]1:8 against the patient's own pathogen. All patients were treated in hospital for four weeks; therapy continued for a minimum of six weeks or until the erythrocyte sedimentation rate (ESR) fell below 20 mm/hr. The clinical course and outcome were similar in both groups. There were no treatment failures nor any relapses during a 12-month follow-up period. This prospective study supports, with controlled data, the concept that acute skeletal infections can be safely and successfully treated with carefully monitored oral therapy.

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