Limits...
Acute Bacterial Skin and Skin Structure Infections Treated with Intravenous Antibiotics in the Emergency Department or Observational Unit: Experience at the Detroit Medical Center.

Claeys KC, Lagnf AM, Patel TB, Jacob MG, Davis SL, Rybak MJ - Infect Dis Ther (2015)

Bottom Line: Demographics, clinical characteristics, and severity were compared between ED and OU patients.OU patients were significantly more likely to be obese, have COPD/asthma, be diagnosed with cellulitis, and meet at least one systemic inflammatory response syndrome (SIRS) criterion.The low rate of ED revisit/hospitalization supports the use of OUs for low acuity ABSSSIs requiring initial IV therapy.

View Article: PubMed Central - PubMed

Affiliation: Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, 48201, USA.

ABSTRACT

Introduction: Acute bacterial skin and skin structure infections (ABSSSIs) are frequently treated in emergency departments (EDs) or observation units (OUs) initially with intravenous (IV) antibiotics before discharge on oral therapy. This study aims to describe ABSSSI patients discharged directly from EDs/OUs.

Methods: This is a retrospective cohort study of patients with ABSSSIs treated in EDs/OUs of the Detroit Medical Center from 2012 to 2014. Adults with less than 24 h of IV antibiotics without hospital admission were included. Demographics, clinical characteristics, and severity were compared between ED and OU patients. Resource utilization, including tissue and blood cultures, and use of radiographic analysis was also collected. The primary outcome was 96-h ED revisit/hospitalization.

Results: Analysis included 308 patients; 219 ED and 89 OU. OU patients were significantly more likely to be obese, have COPD/asthma, be diagnosed with cellulitis, and meet at least one systemic inflammatory response syndrome (SIRS) criterion. Tissue cultures were obtained in 21.7% of abscesses in the ED; 67.9% were in uncomplicated abscesses. In the OU tissue cultures were obtained in 48.8% of abscesses and 37.5% were uncomplicated cases. Blood cultures were drawn in 18.3% of ED patients and 56.2% of OU patients, not significantly associated with the presence of SIRS criteria. Radiology was used in the diagnosis of ABSSSIs in 33.5% of ED versus 69.5% OU patients (p < 0.001), Plain film radiograph being the most common. Thirty patients revisited the ED or required hospitalization within 96 h, 23 from the ED (p = 0.479). Prior history of ABSSSI (adjusted odds ratio [aOR] = 2.382, 95% confidence interval [CI] 1.264-6.346) and location on torso/buttocks (aOR = 2.355, 95% CI 1.067-5.197) were independent predictors.

Conclusions: The low rate of ED revisit/hospitalization supports the use of OUs for low acuity ABSSSIs requiring initial IV therapy. Resource utilization within EDs/OUs for the management of ABSSSIs needs to be evaluated for unnecessary testing/procures.

No MeSH data available.


Related in: MedlinePlus

Study Consolidated Standards of Reporting Trials (CONSORT)
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4471063&req=5

Fig2: Study Consolidated Standards of Reporting Trials (CONSORT)

Mentions: In total, 1877 patients’ electronic medical records were reviewed for study inclusion, of these 1569 were excluded from the current study. Reasons for exclusion are detailed in Fig. 2. The remaining 308 were included in the final analysis, with 219 (71.1%) treated in the ED and 89 (28.9%) sent to the OU. Patient characteristics varied considerably according to setting of care (Table 1). Uncomplicated abscesses were often managed in the ED while cellulitis was more commonly treated in the OU. Patients with comorbid conditions such as obesity (BMI ≥30 kg/m2) or asthma/COPD were more likely to have a stay in the OU (p = 0.05, p = 0.008, respectively). Criteria for SIRS, except for temperature, were also significantly associated with OU treatment. Socioeconomic factors, such as insurance, had no significant impact on setting of care.Fig. 2


Acute Bacterial Skin and Skin Structure Infections Treated with Intravenous Antibiotics in the Emergency Department or Observational Unit: Experience at the Detroit Medical Center.

Claeys KC, Lagnf AM, Patel TB, Jacob MG, Davis SL, Rybak MJ - Infect Dis Ther (2015)

Study Consolidated Standards of Reporting Trials (CONSORT)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4471063&req=5

Fig2: Study Consolidated Standards of Reporting Trials (CONSORT)
Mentions: In total, 1877 patients’ electronic medical records were reviewed for study inclusion, of these 1569 were excluded from the current study. Reasons for exclusion are detailed in Fig. 2. The remaining 308 were included in the final analysis, with 219 (71.1%) treated in the ED and 89 (28.9%) sent to the OU. Patient characteristics varied considerably according to setting of care (Table 1). Uncomplicated abscesses were often managed in the ED while cellulitis was more commonly treated in the OU. Patients with comorbid conditions such as obesity (BMI ≥30 kg/m2) or asthma/COPD were more likely to have a stay in the OU (p = 0.05, p = 0.008, respectively). Criteria for SIRS, except for temperature, were also significantly associated with OU treatment. Socioeconomic factors, such as insurance, had no significant impact on setting of care.Fig. 2

Bottom Line: Demographics, clinical characteristics, and severity were compared between ED and OU patients.OU patients were significantly more likely to be obese, have COPD/asthma, be diagnosed with cellulitis, and meet at least one systemic inflammatory response syndrome (SIRS) criterion.The low rate of ED revisit/hospitalization supports the use of OUs for low acuity ABSSSIs requiring initial IV therapy.

View Article: PubMed Central - PubMed

Affiliation: Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, 48201, USA.

ABSTRACT

Introduction: Acute bacterial skin and skin structure infections (ABSSSIs) are frequently treated in emergency departments (EDs) or observation units (OUs) initially with intravenous (IV) antibiotics before discharge on oral therapy. This study aims to describe ABSSSI patients discharged directly from EDs/OUs.

Methods: This is a retrospective cohort study of patients with ABSSSIs treated in EDs/OUs of the Detroit Medical Center from 2012 to 2014. Adults with less than 24 h of IV antibiotics without hospital admission were included. Demographics, clinical characteristics, and severity were compared between ED and OU patients. Resource utilization, including tissue and blood cultures, and use of radiographic analysis was also collected. The primary outcome was 96-h ED revisit/hospitalization.

Results: Analysis included 308 patients; 219 ED and 89 OU. OU patients were significantly more likely to be obese, have COPD/asthma, be diagnosed with cellulitis, and meet at least one systemic inflammatory response syndrome (SIRS) criterion. Tissue cultures were obtained in 21.7% of abscesses in the ED; 67.9% were in uncomplicated abscesses. In the OU tissue cultures were obtained in 48.8% of abscesses and 37.5% were uncomplicated cases. Blood cultures were drawn in 18.3% of ED patients and 56.2% of OU patients, not significantly associated with the presence of SIRS criteria. Radiology was used in the diagnosis of ABSSSIs in 33.5% of ED versus 69.5% OU patients (p < 0.001), Plain film radiograph being the most common. Thirty patients revisited the ED or required hospitalization within 96 h, 23 from the ED (p = 0.479). Prior history of ABSSSI (adjusted odds ratio [aOR] = 2.382, 95% confidence interval [CI] 1.264-6.346) and location on torso/buttocks (aOR = 2.355, 95% CI 1.067-5.197) were independent predictors.

Conclusions: The low rate of ED revisit/hospitalization supports the use of OUs for low acuity ABSSSIs requiring initial IV therapy. Resource utilization within EDs/OUs for the management of ABSSSIs needs to be evaluated for unnecessary testing/procures.

No MeSH data available.


Related in: MedlinePlus