Treatment of bacterial skin infections in ED observation units: factors influencing prescribing practice - 05/12/15
, Gregory Wu, MD a, Vanni Bucci, PhD b, Andrew Fischer, MD a, Edward W. Boyer, MD, PhD a, Patricia L. Hibberd, MD, PhD cAbstract |
Objective |
The Infectious Disease Society of America (IDSA) publishes evidence-based guidelines for the treatment of skin and soft tissue infections. How closely physicians follow these guidelines is unknown, particularly in the emergency department observation unit (EDOU) where increasing numbers of patients are treatment for these infections. Our objectives were to describe (1) the antibiotic treatment patterns EDOU patients, (2) physicians' adherence to the IDSA guidelines, and (3) factors that influence physician's prescribing practices.
Methods |
This prospective cohort enrolled adult patients discharged from an EDOU at an academic medical center after treatment for a skin or soft tissue infection. Information was collected from chart review and patient interview pertaining to the patient's sociodemographic characteristics, presenting illness, and antibiotic treatment regimens. Treatment regimens were compared with national guidelines.
Results |
The study included 193 patients of which only 43% were treated according to IDSA guidelines, 42% were overtreated, and 15% were undertreated. Women were more likely to be undertreated (relative risk, 1.58; 95% confidence interval, 1.21-2.06), whereas patients 50 years and older were at risk for overtreatment (relative risk, 1.44; 95% confidence interval, 1.03-2.02). Women also received shorter courses of antibiotic therapy with an average of 9.6 days of treatment compared with 10.6 days for men.
Conclusions |
Physician antibiotic prescribing practices demonstrated poor adherence to IDSA guidelines and were influenced by the patient's age and sex. Standardized antibiotic protocols for treatment of skin and soft tissue infections to IDSA guidelines in the EDOU would minimize physician bias.
Le texte complet de cet article est disponible en PDF.Plan
| ☆ | Meetings: None. |
| ☆☆ | Grant: This study was designed and carried out at the University of Massachusetts Medical School and was supported by an intradepartmental grant through the Department of Emergency Medicine. VB is supported by an National Institutes of Health award 1R15AI112985-01A1 and PLH by 5K24AT003683-09. |
| ★ | Conflicts of interest: None of the authors listed have any conflict of interest. |
| ★★ | Author contributions: JPH, EWB, and PLH conceived the study, designed the trial, and obtained research funding. JPH, GW, and AF supervised the conduct of the trial and data collection. JPH, GW, and AF recruited participating centers and patients and managed the data, including collection and quality control. JPH and VB provided statistical advice on study design and analyzed the data; JPH drafted the manuscript, and all authors contributed substantially to its revision. JPH takes responsibility for the paper as a whole. |
Vol 33 - N° 12
P. 1780-1785 - décembre 2015 Retour au numéro
Article précédent
- Effect of valproic acid combined with therapeutic hypothermia on neurologic outcome in asphyxial cardiac arrest model of rats
- Jae Hyuk Lee, Kyuseok Kim, You Hwan Jo, Min Ji Lee, Ji Eun Hwang, Min A. Kim
- Assessing the rates of error and adverse events in the ED
- Richard S. Klasco, Richard E. Wolfe, Matthew Wong, Jonathan Edlow, David Chiu, Phillip D. Anderson, Shamai A. Grossman
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?