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Opportunities for antimicrobial stewardship in patients with acute bacterial skin and skin structure infections who are unsuitable for beta-lactam antibiotics: a multicenter prospective observational study

Opportunities for antimicrobial stewardship in patients with acute bacterial skin and skin structure infections who are unsuitable for beta-lactam antibiotics: a multicenter prospective observational study
Opportunities for antimicrobial stewardship in patients with acute bacterial skin and skin structure infections who are unsuitable for beta-lactam antibiotics: a multicenter prospective observational study
Purpose The objective of this prospective, observational study was to describe the treatment, severity assessment and healthcare resources required for management of patients with acute bacterial skin and skin structure infections who were unsuitable for beta-lactam antibiotic treatments. Methods Patients were enrolled across five secondary care National Health Service hospitals. Eligible patients had a diagnosis of acute bacterial skin and skin structure infection and were considered unsuitable for beta-lactam antibiotics (e.g. confirmed/suspected methicillin-resistant Staphylococcus aureus, beta-lactam allergy). Data regarding diagnosis, severity of the infection, antibiotic treatment and patient management were collected. Results 145 patients with acute bacterial skin and skin structure infection were included; 79% (n = 115) patients received greater than two antibiotic regimens; median length of the first antibiotic regimen was 2 days (interquartile range of 1-5); median time to switch from intravenous to oral antibiotics was 4 days (interquartile range of 3-8, n = 72/107); 25% (n = 10/40) patients with Eron class 1 infection had systemic inflammatory response syndrome, suggesting they were misclassified. A higher proportion of patients with systemic inflammatory response syndrome received treatment in an inpatient setting, and their length of stay was prolonged in comparison with patients without systemic inflammatory response syndrome. Conclusion There exists an urgent need for more focused antimicrobial stewardship strategies and tools for standardised clinical assessment of acute bacterial skin and skin structure infection severity in patients who are unsuitable for beta-lactam antibiotics. This will lead to optimised antimicrobial treatment strategies and ensure effective healthcare resource utilisation.
2049-9361
Sandoe, Jonathan A.T.
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Saeed, Kordo
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Guleri, Achyut
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Hand, Kieran S.
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Dillon, Ryan
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Allen, Mike
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Mayes, Amazigom
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Glen, Fiona
af181f7d-2387-4fc6-b507-586991bfa115
Gonzalez-Ruiz, Armando
cd85bb0a-0d30-4c11-9ddd-030e6e91a19d
Sandoe, Jonathan A.T.
2e6de402-700a-4ab1-9b79-9c375c20ca13
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Guleri, Achyut
2877b6b1-82fa-4329-a8e9-0bd865f632f7
Hand, Kieran S.
5407b07a-7b4b-47e2-b0cf-d662f7d7a3e6
Dillon, Ryan
d7580bba-7ae3-4df9-813e-b036cc11fb01
Allen, Mike
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Mayes, Amazigom
99bb9391-83e8-4378-b327-f442387d2afd
Glen, Fiona
af181f7d-2387-4fc6-b507-586991bfa115
Gonzalez-Ruiz, Armando
cd85bb0a-0d30-4c11-9ddd-030e6e91a19d

Sandoe, Jonathan A.T., Saeed, Kordo, Guleri, Achyut, Hand, Kieran S., Dillon, Ryan, Allen, Mike, Mayes, Amazigom, Glen, Fiona and Gonzalez-Ruiz, Armando (2019) Opportunities for antimicrobial stewardship in patients with acute bacterial skin and skin structure infections who are unsuitable for beta-lactam antibiotics: a multicenter prospective observational study. Therapeutic Advances in Infectious Disease, 6. (doi:10.1177/2049936118823655).

Record type: Article

Abstract

Purpose The objective of this prospective, observational study was to describe the treatment, severity assessment and healthcare resources required for management of patients with acute bacterial skin and skin structure infections who were unsuitable for beta-lactam antibiotic treatments. Methods Patients were enrolled across five secondary care National Health Service hospitals. Eligible patients had a diagnosis of acute bacterial skin and skin structure infection and were considered unsuitable for beta-lactam antibiotics (e.g. confirmed/suspected methicillin-resistant Staphylococcus aureus, beta-lactam allergy). Data regarding diagnosis, severity of the infection, antibiotic treatment and patient management were collected. Results 145 patients with acute bacterial skin and skin structure infection were included; 79% (n = 115) patients received greater than two antibiotic regimens; median length of the first antibiotic regimen was 2 days (interquartile range of 1-5); median time to switch from intravenous to oral antibiotics was 4 days (interquartile range of 3-8, n = 72/107); 25% (n = 10/40) patients with Eron class 1 infection had systemic inflammatory response syndrome, suggesting they were misclassified. A higher proportion of patients with systemic inflammatory response syndrome received treatment in an inpatient setting, and their length of stay was prolonged in comparison with patients without systemic inflammatory response syndrome. Conclusion There exists an urgent need for more focused antimicrobial stewardship strategies and tools for standardised clinical assessment of acute bacterial skin and skin structure infection severity in patients who are unsuitable for beta-lactam antibiotics. This will lead to optimised antimicrobial treatment strategies and ensure effective healthcare resource utilisation.

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Published date: 4 February 2019

Identifiers

Local EPrints ID: 447472
URI: http://eprints.soton.ac.uk/id/eprint/447472
ISSN: 2049-9361
PURE UUID: 934f34eb-9463-4f71-b43a-2655ff1cdabf
ORCID for Kordo Saeed: ORCID iD orcid.org/0000-0003-0123-0302
ORCID for Kieran S. Hand: ORCID iD orcid.org/0000-0002-3834-2415

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Date deposited: 12 Mar 2021 17:31
Last modified: 17 Mar 2024 03:56

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Contributors

Author: Jonathan A.T. Sandoe
Author: Kordo Saeed ORCID iD
Author: Achyut Guleri
Author: Kieran S. Hand ORCID iD
Author: Ryan Dillon
Author: Mike Allen
Author: Amazigom Mayes
Author: Fiona Glen
Author: Armando Gonzalez-Ruiz

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