Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess

June 28, 2011 at 1:27 am Leave a comment

Archives of Internal Medicine June 27, 2011 V.171 N.12 P.1072-1079

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Timothy C. Jenkins, MD; Bryan C. Knepper, MPH, MSc; Allison L. Sabel, MD, PhD, MPH; Ellen E. Sarcone, MD; Jeremy A. Long, MD, MPH; Jason S. Haukoos, MD, MSc; Steven J. Morgan, MD; Walter L. Biffl, MD; Andrew W. Steele, MD, MPH, MSc; Connie S. Price, MD; Philip S. Mehler, MD; William J. Burman, MD

Department of Medicine (Drs Jenkins, Sarcone, Long, Price, Mehler, and Burman), Division of Infectious Diseases (Drs Jenkins, Price, and Burman), and Departments of Patient Safety and Quality (Mr Knepper and Drs Sabel and Mehler), Emergency Medicine (Dr Haukoos), Orthopaedic Surgery (Dr Morgan), General Surgery (Dr Biffl), and eHealth Services (Dr Steele), Denver Health Medical Center, Denver, Colorado; Department of Medicine (Drs Jenkins, Sarcone, Long, Steele, Price, Mehler, and Burman), Division of Infectious Diseases (Drs Jenkins, Price, and Burman), and Departments of Emergency Medicine (Dr Haukoos), Orthopaedic Surgery (Dr Morgan), and General Surgery (Dr Biffl), University of Colorado Denver, Aurora; and Departments of Biostatistics and Informatics (Dr Sabel) and Epidemiology (Dr Haukoos), Colorado School of Public Health, Aurora.

Background

Cellulitis and cutaneous abscess are among the most common infections leading to hospitalization, yet optimal management strategies have not been adequately studied. We hypothesized that implementation of an institutional guideline to standardize and streamline the evaluation and treatment of inpatient cellulitis and abscess would decrease antibiotic and health care resource utilization.

Methods

A retrospective preintervention-postintervention study was performed to compare management before and after implementation of the guideline (January 1, 2007–December 31, 2007, and July 9, 2009–July 8, 2010).

Results

A total of 169 patients (66 with cellulitis, 103 with abscess) were included in the baseline cohort, and 175 (82 with cellulitis, 93 with abscess) were included in the intervention cohort. The intervention led to a significant decrease in use of microbiological cultures (80% vs 66%; P = .003) and fewer requests for inpatient consultations (46% vs 30%; P = .004). The median duration of antibiotic therapy decreased from 13 days (interquartile range [IQR], 10-15 days) to 10 days (IQR, 9-12 days) (P < .001). Fewer patients received antimicrobial agents with broad aerobic gram-negative activity (66% vs 36%; P < .001), antipseudomonal activity (28% vs 18%; P = .02), or broad anaerobic activity (76% vs 49%; P < .001). Clinical failure occurred in 7.7% and 7.4% of cases (P = .93), respectively.

Conclusion

Implementation of a guideline for the management of inpatient cellulitis and cutaneous abscess led to shorter durations of more targeted antibiotic therapy and decreased use of resources without adversely affecting clinical outcomes.

abstract

http://archinte.ama-assn.org/cgi/content/abstract/171/12/1072?etoc

Entry filed under: Antimicrobianos, GUIDELINES, Infecciones en piel y tej blandos.

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