title: Appropriateness of antibiotic management of uncomplicated skin and soft tissue infections in hospitalized adult patients.
abstract: BACKGROUND
  Skin and soft tissue infections (SSTIs) are a leading cause for hospitalizations in the United States. Few studies have addressed the appropriateness of antibiotic therapy in the management of SSTIs without complicating factors. We aimed to determine the appropriateness of antibiotic treatment duration for hospitalized adult patients with uncomplicated SSTIs.
  
  
  METHODS
  This was a retrospective analysis performed at two academic medical centers in Pittsburgh, Pennsylvania on patients aged 18 years and older with primary ICD-9 code for SSTIs admitted August 1st, 2014-March 31st, 2015. The primary outcome was the appropriateness of antibiotic treatment duration for uncomplicated SSTIs. Secondary objectives included the appropriateness of antibiotic agent spectrum, duration of inpatient length of stay (LOS), utilization of blood cultures and advanced imaging modalities, and re-hospitalization for SSTI within 30 days of discharge from the index admission.
  
  
  RESULTS
  A total of 163 episodes were included in the cohort. The mean duration of total antibiotic therapy was 12.6 days. Appropriate duration was defined as receipt of total antibiotic duration of less than 10 days and occurred in 20.2% of patients. Twenty eight percent of patients received antibiotics for greater than 14 days. Seventy three (44.8%) patients received greater than 24 h of inappropriate extended spectrum gram-negative coverage; 65 (39.9%) received anaerobic coverage.
  
  
  CONCLUSIONS
  In the majority of patients, treatment duration was excessive. Inappropriate broad spectrum antibiotic selection was utilized with regularity for SSTIs without complicating factors. The management of uncomplicated SSTIs represents a significant opportunity for antimicrobial stewardship.
authors.affiliation: Department of Medicine and Division of Infectious Diseases, Allegheny General Hospital, 320 East North Ave. East Wing Office Building, Suite 406, Pittsburgh, PA, 15212, USA. Thomas.Walsh@ahn.org.|Department of Medicine and Division of Infectious Diseases, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA. Thomas.Walsh@ahn.org.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Walsh
authors.affiliation: Department of Pharmacy, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Chan
authors.affiliation: Department of Pharmacy, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA.
authors.forename: Chelsea I
authors.initials: CI
authors.lastname: Konopka
authors.affiliation: Division of Hospital Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA.|Division of Hospital Medicine, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Burkitt
authors.affiliation: Department of Medicine and Division of Infectious Diseases, Allegheny General Hospital, 320 East North Ave. East Wing Office Building, Suite 406, Pittsburgh, PA, 15212, USA.|Department of Medicine and Division of Infectious Diseases, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Moffa
authors.affiliation: Department of Pharmacy, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA.
authors.forename: Derek N
authors.initials: DN
authors.lastname: Bremmer
authors.affiliation: Department of Medicine and Division of Infectious Diseases, Allegheny General Hospital, 320 East North Ave. East Wing Office Building, Suite 406, Pittsburgh, PA, 15212, USA.|Department of Medicine and Division of Infectious Diseases, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA.
authors.forename: Monika A
authors.initials: MA
authors.lastname: Murillo
authors.affiliation: Center for Inclusion Health, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Watson
authors.affiliation: Department of Pharmacy, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA.
authors.forename: Noreen H
authors.initials: NH
authors.lastname: Chan-Tompkins
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010414:Pennsylvania; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000382:microbiology; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic utilization; Cellulitis; Skin and soft tissue infection; Subcutaneous abscess