title: Antibiotic prescribing practices in a multicenter cohort of patients hospitalized for acute bacterial skin and skin structure infection.
abstract: OBJECTIVE
  Hospitalizations for acute bacterial skin and skin structure infection (ABSSSI) are common. Optimizing antibiotic use for ABSSSIs requires an understanding of current management. The objective of this study was to evaluate antibiotic prescribing practices and factors affecting prescribing in a diverse group of hospitals.
  
  
  METHODS
  Multicenter, retrospective cohort study.
  
  
  METHODS
  Seven community and academic hospitals.
  
  
  METHODS
  Children and adults hospitalized between June 2010 and May 2012 for cellulitis, wound infection, or cutaneous abscess were eligible. The primary endpoint was a composite of 2 prescribing practices representing potentially avoidable antibiotic exposure: (1) use of antibiotics with a broad spectrum of activity against gram-negative bacteria or (2) treatment duration greater than 10 days.
  
  
  RESULTS
  A total of 533 cases were included: 320 with nonpurulent cellulitis, 44 with wound infection or purulent cellulitis, and 169 with abscess. Of 492 cases with complete prescribing data, the primary endpoint occurred in 394 (80%) cases and varied significantly across hospitals (64%-97%; P < .001). By logistic regression, independent predictors of the primary endpoint included wound infection or purulent cellulitis (odds ratio [OR], 5.12 [95% confidence interval (CI)], 1.46-17.88), head or neck involvement (OR, 2.83 [95% CI, 1.17-6.82]), adult cases (OR, 2.20 [95% CI, 1.18-4.11]), and admission to a community hospital (OR, 1.90 [95% CI, 1.05-3.44]).
  
  
  CONCLUSIONS
  Among patients hospitalized for ABSSSI, use of antibiotics with broad gram-negative activity or treatment courses longer than 10 days were common. There may be substantial opportunity to reduce antibiotic exposure through shorter courses of therapy targeting gram-positive bacteria.
authors.affiliation: Department of Medicine and Division of Infectious Diseases, Denver Health, Denver, Colorado.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Jenkins
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Knepper
authors.forename: S Jason
authors.initials: SJ
authors.lastname: Moore
authors.forename: Sean T
authors.initials: ST
authors.lastname: O'Leary
authors.lastname: Brooke Caldwell
authors.forename: Carla C
authors.initials: CC
authors.lastname: Saveli
authors.forename: Sean W
authors.initials: SW
authors.lastname: Pawlowski
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Perlman
authors.forename: Bruce D
authors.initials: BD
authors.lastname: McCollister
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*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D014946:Wound Infection / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents