Comparative analysis of empiric antimicrobial treatments for skin and soft tissue infections in newly hospitalized patients.
OBJECTIVE
Intravenous vancomycin is the standard empiric treatment for complicated skin and soft tissue infections (SSTIs) due to its coverage against methicillin-resistant Staphylococcus aureus (MRSA). The objective of this study was to compare the hospital length of stay (LOS) between vancomycin-treated patients and patients receiving newer anti-MRSA agents. The study also aimed to identify factors associated with therapy change in patients receiving vancomycin on admission.


METHODS
Electronic medical records were used to conduct this retrospective cohort study. The LOS was compared among 5 groups of adult patients with admission diagnoses for SSTI who were initiated on linezolid, daptomycin, ceftaroline, tigecycline, or vancomycin. Survival analysis was used to identify factors associated with therapy change from vancomycin to another study medication.


RESULTS
Vancomycin was prescribed in 1046 (92%) admissions. Although none of the between-group differences in LOS reached statistical significance, there was a trend toward shorter LOS in vancomycin-treated patients compared to linezolid-treated patients (P = .059). Coagulopathy was independently associated with increased likelihood of therapy change from vancomycin (hazard ratio = 4.71; P <.001).


CONCLUSIONS
In the treatment of SSTI, newer agents result in LOS comparable to vancomycin. In patients initiated on vancomycin, therapy change was associated with longer LOS. Coagulopathy was independently associated with increased probability of therapy change.
Department of Pharmacy, John C. Lincoln Health Network, North Mountain Hospital, Phoenix, AZ, USA.
Cyrus
C
Yazdani
Nancy
N
Hanna
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin
infectious disease