title: Relationship between Adherence to Oral Antibiotics and Postdischarge Clinical Outcomes among Patients Hospitalized with Staphylococcus aureus Skin Infections.
abstract: Skin and soft tissue infections are common and frequently recur. Poor adherence to antibiotic therapy may lead to suboptimal clinical outcomes. However, adherence to oral antibiotic therapy for skin and soft tissue infections and its relationship to clinical outcomes have not been examined. We enrolled adult patients hospitalized with uncomplicated skin and soft tissue infections caused by Staphylococcus aureus who were being discharged with oral antibiotics to complete therapy. We fit the participants' pill bottles with an electronic bottle cap that recorded each pill bottle opening, administered an in-person standardized questionnaire at enrollment, 14 days, and 30 days, and reviewed the participants' medical records to determine outcomes. Our primary outcome was poor clinical response, defined as a change in antibiotic therapy, new incision-and-drainage procedure, or new skin infection within 30 days of hospital discharge. Of our 188 participants, 87 had complete data available for analysis. Among these participants, 40 (46%) had a poor clinical response at 30 days. The mean electronically measured adherence to antibiotic therapy was significantly different than the self-reported adherence (57% versus 96%; P < 0.0001). In a multivariable model, poor clinical response at 30 days was associated with patients having lower adherence, being nondiabetic, and reporting a lack of illicit drug use within the previous 12 months (P < 0.05). In conclusion, we found that patient adherence to oral antibiotic therapy for a skin and soft tissue infection after hospital discharge was low (57%) and associated with poor clinical outcome. Patients commonly overstate their medication adherence, which may make identification of patients at risk for nonadherence and poor outcomes challenging. Further studies are needed to improve postdischarge antibiotic adherence after skin and soft tissue infections.
authors.affiliation: Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA David Geffen School of Medicine at UCLA and Harbor-UCLA Medical Center, Los Angeles, California, USA Science 37, Inc., and Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Eells
authors.affiliation: Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA College of Pharmacy, Western University of Health Sciences, Pomona, California, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Nguyen
authors.affiliation: College of Pharmacy, Western University of Health Sciences, Pomona, California, USA.
authors.forename: Jina
authors.initials: J
authors.lastname: Jung
authors.affiliation: Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA.
authors.forename: Raul
authors.initials: R
authors.lastname: Macias-Gil
authors.affiliation: Department of Emergency Medicine, University of California-Davis, Sacramento, California, USA.
authors.forename: Larissa
authors.initials: L
authors.lastname: May
authors.affiliation: Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA David Geffen School of Medicine at UCLA and Harbor-UCLA Medical Center, Los Angeles, California, USA Lgmiller@ucla.edu.
authors.forename: Loren G
authors.initials: LG
authors.lastname: Miller
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000472:pathogenicity*
chemical_list: D000900:Anti-Bacterial Agents