title: Current Prescribing Practices for Skin and Soft Tissue Infections in Nursing Homes.
abstract: OBJECTIVE
  Antibiotic stewardship has been called for across all sites of health care, including nursing homes (NHs). Skin and soft tissue infections (SSTIs) are the third most common indication for antibiotics in the NH, and so should be a focus of stewardship. This study audited medical records to identify signs and symptoms of SSTIs treated with antibiotics in relation to the McGeer criteria for surveillance, the Loeb minimum criteria for antibiotic initiation, and prescribing recommendations of the Infectious Disease Society of America.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Thirty-one NHs in Southeastern United States.
  
  
  METHODS
  Chart data from a random sample of 161 antibiotic prescriptions for SSTIs were abstracted. To meet the McGeer criteria, pus was present at a suspected SSTI site, or at least four of the following findings were documented as present at the site: new or worsening warmth, redness, swelling, tenderness, serous drainage, or a constitutional finding. The Loeb minimum criteria for initiating antibiotics included findings of new or increasing purulent drainage at a suspected SSTI site or at least two of the following findings: fever or new or worsening redness, tenderness, warmth, or swelling at the suspected site. Audits also collected the name, route, and duration of the associated antibiotic. Analyses calculated the types of diagnoses and evaluated associations between published criteria and prescribing.
  
  
  RESULTS
  Cellulitis, skin/soft tissue injury with infection, and abscess were diagnosed in 37% (N = 59), 18% (N = 29), and 16% (N = 26) of cases, respectively; 27% (N = 43) had less specific diagnoses. The McGeer criteria were met in 25% (N = 40), and the Loeb minimum criteria were met in 48% (N = 77) of cases. Doxycycline was the most frequently prescribed antibiotic. The mean treatment length was 9.6 days (standard deviation, 5.6), and the median length of treatment was 8.5 days (range, 3-45).
  
  
  CONCLUSIONS
  SSTIs are not routinely diagnosed or treated according to recommended standards of care, and prescriptions for systemic antibiotics appear to be frequently initiated without regard to recommended definitions of infection or therapies for the associated diagnoses. These findings indicate that SSTIs present various opportunities to improve antibiotic stewardship.
authors.affiliation: Division of Geriatric Medicine, Center for Aging and Health, University of North Carolina, Chapel Hill, NC. Electronic address: diana_feldstein@med.unc.edu.
authors.forename: Diana
authors.initials: D
authors.lastname: Feldstein
authors.affiliation: Department of Family Medicine, University of North Carolina, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.
authors.forename: David
authors.initials: D
authors.lastname: Weber
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Ward
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC.
authors.forename: David
authors.initials: D
authors.lastname: Reed
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; School of Social Work, University of North Carolina, Chapel Hill, NC.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D009735:Nursing Homes; D010818:Practice Patterns, Physicians'; D018461:Soft Tissue Infections / Q000188:drug therapy*; D015144:Southeastern United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: Skin infection; antibiotic prescribing; nursing home