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Outpatient antimicrobial stewardship targets for treatment of skin and soft-tissue infections

Published online by Cambridge University Press:  02 July 2018

Preeti Jaggi ,
Ling Wang ,
Sean Gleeson ,
Melissa Moore-Clingenpeel  and
Joshua R. Watson
Preeti Jaggi*
Affiliation:
Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
Ling Wang
Affiliation:
Nationwide Children’s Hospital, Partners for Kids, Columbus, Ohio
Sean Gleeson
Affiliation:
Department of Pediatrics, The Ohio State University, Nationwide Children’s Hospital, Partners for Kids, Columbus, Ohio
Melissa Moore-Clingenpeel
Affiliation:
Biostatistics Core, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
Joshua R. Watson*
Affiliation:
Department of Pediatrics, The Ohio State University, Nationwide Children’s Hospital, Partners for Kids, Columbus, Ohio
*
Author for correspondence: Preeti Jaggi, MD, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, NE, Rm. 504A, Atlanta, GA, 30322. E-mail: preeti.jaggi@emory.edu or Joshua R. Watson, MD, Division of Infectious Diseases, Department of Pediatrics, The Ohio State University, Nationwide Children’s Hospital, Partners for Kids, 700 Children’s Drive, Columbus, OH 43205. E-mail: joshua.watson@nationwidechildrens.org
Author for correspondence: Preeti Jaggi, MD, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, NE, Rm. 504A, Atlanta, GA, 30322. E-mail: preeti.jaggi@emory.edu or Joshua R. Watson, MD, Division of Infectious Diseases, Department of Pediatrics, The Ohio State University, Nationwide Children’s Hospital, Partners for Kids, 700 Children’s Drive, Columbus, OH 43205. E-mail: joshua.watson@nationwidechildrens.org
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Abstract

Objective

We sought to identify factors associated with long duration and/or non–first-line choice of treatment for pediatric skin and soft-tissue infections (SSTIs).

Design

Retrospective cohort study.

Setting

Ambulatory encounter claims of Medicaid-insured children lacking chronic medical conditions treated for SSTI and/or animal bite injury in Ohio in 2014.

Methods

For all diagnoses, long treatment duration was defined as treatment >7 days. Non–first-line choice of treatment for SSTI included treatment with 2 antimicrobials dispensed on the same calendar day or any treatment not listed in the Infectious Diseases Society of America guidelines. The adjusted odds of (1) long treatment duration and (2) non–first-line choice of treatment were calculated for patient age, prescriber type, and patient county of residence characteristics (ie, rural vs metropolitan area and poverty rate).

Results

Of 10,310 encounters with complete data available, long treatment duration was prescribed in 7,968 (77.3%). The most common duration of treatment prescribed was 10 days. A non–first-line choice was prescribed in 1,030 encounters (10%). Dispensation of 2 antimicrobials on the same calendar day was the most common reason for the non–first-line choice, and of these, trimethoprim-sulfamethoxazole plus a first-generation cephalosporin was the most common regimen. Compared to pediatricians, the adjusted odds ratio of long treatment duration was significantly lower for all other primary care specialties. Conversely, nonpediatricians were more likely to prescribe a non–first-line treatment choice. Patient residence in a high-poverty county increased the odds of both long duration and non–first-line choice of treatment.

Conclusions

Healthcare claims may be utilized to measure opportunities for first-line choice and/or shorter duration of treatment for SSTI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 8 , August 2018 , pp. 936 - 940
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

REFERENCES

1. Zheng, G, Horton, DB, Deaciuc, AG, Dwoskin, LP, Crooks, PA. Des-keto lobeline analogs with increased potency and selectivity at dopamine and serotonin transporters. Bioorg Med Chem Lett 2006;16:5018–5021.Google Scholar
2. Gerber, JS, Prasad, PA, Fiks, AG, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA 2013;309:2345–2352.Google Scholar
3. Hersh, AL, Shapiro, DJ, Pavia, AT, Shah, SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics 2011;128:1053–1061.Google Scholar
4. Gerber, JS, Kronman, MP, Ross, RK, et al. Identifying targets for antimicrobial stewardship in children’s hospitals. Infect Control Hosp Epidemiol 2013;34:1252–1258.Google Scholar
5. Fleming-Dutra, KE, Hersh, AL, Shapiro, DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 2016;315:1864–1873.Google Scholar
6. Schuler, CL, Courter, JD, Conneely, SE, et al. Decreasing duration of antibiotic prescribing for uncomplicated skin and soft tissue infections. Pediatrics 2016;137:e20151223.Google Scholar
7. Watson, JR, Wang, L, Klima, J, et al. Healthcare claims data: an underutilized tool for pediatric outpatient antimicrobial stewardship. Clin Infect Dis 2017;64:1479–1485.Google Scholar
8. Feudtner, C, Christakis, DA, Connell, FA. Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980–1997. Pediatrics 2000;106:205–209.Google Scholar
9. Liu, C, Bayer, A, Cosgrove, SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 2011;52:285–292.Google Scholar
10. Stevens, DL, Bisno, AL, Chambers, HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014;59:e10–e52.Google Scholar
11. Small area income and poverty estimates program. US Census Bureau website. https://www.census.gov/programs-surveys/saipe.html. Published 2016. Accessed May 15, 2018.Google Scholar
12. Saha, D, Patel, J, Buckingham, D, Thornton, D, Barber, T, Watson, JR. Urine culture follow-up and antimicrobial stewardship in a pediatric urgent care network. Pediatrics 2017;139.Google Scholar
13. Hepburn, MJ, Dooley, DP, Skidmore, PJ, Ellis, MW, Starnes, WF, Hasewinkle, WC. Comparison of short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis. Arch Intern Med 2004;164:1669–1674.Google Scholar
14. Daum, RS, Miller, LG, Immergluck, L, et al. A placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J Med 2017; 376:2545–2555.Google Scholar
15. Talan, DA, Mower, WR, Krishnadasan, A, et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med 2016;374:823–832.Google Scholar
16. Holmes, L, Ma, C, Qiao, H, et al. Trimethoprim-sulfamethoxazole therapy reduces failure and recurrence in methicillin-resistant Staphylococcus aureus skin abscesses after surgical drainage. J Pediatrics 2016;169:128–134; e121.Google Scholar
17. Medeiros, I, Saconato, H. Antibiotic prophylaxis for mammalian bites. Cochrane Data Syst Rev 2001:CD001738.Google Scholar
18. Committee on Infectious Diseases; American Academy of Pediatrics; David W. Kimberlin M, FAAP; Michael T. Brady, MD, FAAP; Mary Anne Jackson, MD, FAAP; Sarah S. Long, MD, FAAP. American Academy of Pediatrics Red Book, 30th ed. 2015.Google Scholar
19. Ference, EH, Min, JY, Chandra, RK, et al. Antibiotic prescribing by physicians versus nurse practitioners for pediatric upper respiratory infections. Ann Otol Rhinol Laryngol 2016;125:982–991.Google Scholar
20. Moran, GJ, Krishnadasan, A, Mower, WR, et al. Effect of cephalexin plus trimethoprim-sulfamethoxazole vs cephalexin alone on clinical cure of uncomplicated cellulitis: a randomized clinical trial. JAMA 2017;317:2088–2096.Google Scholar
21. Pallin, DJ, Binder, WD, Allen, MB, et al. Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clin Infect Dis 2013;56:1754–1762.Google Scholar
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