title: Decreased antibiotic utilization after implementation of a guideline for inpatient cellulitis and cutaneous abscess.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Denver Health Medical Center, Denver, CO 80204, USA. timothy.jenkins@dhha.org
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Jenkins
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Knepper
authors.forename: Allison L
authors.initials: AL
authors.lastname: Sabel
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Sarcone
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Long
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Morgan
authors.forename: Walter L
authors.initials: WL
authors.lastname: Biffl
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Steele
authors.forename: Connie S
authors.initials: CS
authors.lastname: Price
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
authors.forename: William J
authors.initials: WJ
authors.lastname: Burman
mesh_terms: D000038:Abscess / Q000188:drug therapy*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002481:Cellulitis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012871:Skin Diseases / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents