title: Treatment of bacterial skin infections in ED observation units: factors influencing prescribing practice.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA. Electronic address: john.haran@umassmed.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Haran
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wu
authors.affiliation: Department of Biology, University of Massachusetts Dartmouth, North Dartmouth, MA.
authors.forename: Vanni
authors.initials: V
authors.lastname: Bucci
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fischer
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Boyer
authors.affiliation: Department of Pediatrics and Division of Global Health, Massachusetts General Hospital, Boston, MA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012737:Sex Factors; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents