title: Inappropriate initial antibiotic treatment for complicated skin and soft tissue infections in hospitalized patients: incidence and associated factors.
abstract: We analyzed 525 hospitalized adults treated with intravenous antibiotic(s) for complicated skin and soft tissue infections (cSSTIs) to assess incidence of, and risk factors associated with, inappropriate initial antibiotic treatment (IIAT). IIAT was given to 22.5% of enrolled patients. The rate of IIAT did not vary by type of facility (academic versus community) but was significantly higher in rural than urban hospitals (38.9% versus 21.3%, P = 0.02). Pathogens were exclusively gram-positive in 68% of patients, exclusively gram-negative in 13%, and mixed in 19%. Staphylococcus aureus was the most frequently isolated pathogen (in 65%), 54% of which were methicillin-resistant. Significant independent risk factors for IIAT were: admission to a rural hospital (odds ratio = 2.34; 95% confidence interval: 1.06-5.19), dialysis treatment (3.86; 1.15-12.93), cancer other than non-melanoma skin cancer (5.23; 1.78-15.36), and infection with gram-negative (3.43; 1.79-6.60) or mixed (4.52; 2.62-7.78) pathogens. IIAT for cSSTIs was relatively frequent in these hospitalized patients, especially those with selected risk factors.
authors.affiliation: University of Oxford, Oxford, UK; University of Washington, Seattle, WA, USA. Electronic address: balipsky@uw.edu.
authors.forename: B A
authors.initials: BA
authors.lastname: Lipsky
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Napolitano
authors.affiliation: Olive View-UCLA Medical Center, Sylmar, CA, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Moran
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: L
authors.initials: L
authors.lastname: Vo
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: S
authors.initials: S
authors.lastname: Nicholson
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: M
authors.initials: M
authors.lastname: Kim
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Complicated skin and soft tissue infections; Inappropriate antibiotics treatment; Incidence