scholarly journals Predictors of Oral Antibiotic Treatment Failure for Nonpurulent Skin and Soft Tissue Infections in the Emergency Department

2018 ◽  
Author(s):  
Krishan Yadav ◽  
Kathryn N. Suh ◽  
Debra Eagles ◽  
John MacIsaac ◽  
Darmyn Ritchie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Treatment Failure ◽  
Antibiotic Treatment ◽  
Oral Antibiotic ◽  
Soft Tissue Infections

scholarly journals LO52: Predictors of oral antibiotic treatment failure for non-purulent skin and soft tissue infections in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S24-S25 ◽  
Author(s):  
K. Yadav ◽  
K. Suh ◽  
D. Eagles ◽  
J. MacIsaac ◽  
D. Ritchie ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Antibiotic Treatment ◽  
Oral Antibiotic ◽  
Soft Tissue Infections ◽  
Emergency Physicians ◽  
Intravenous Antibiotic ◽  
The Past ◽  
History Of ◽  
Chronic Ulcers ◽  
Mrsa Colonization

Introduction: Current guideline recommendations for optimal management of non-purulent skin and soft tissue infections (SSTIs) are based on expert consensus. There is currently a lack of evidence to guide emergency physicians on when to select oral versus intravenous antibiotic therapy. The primary objective was to identify risk factors associated with oral antibiotic treatment failure. A secondary objective was to describe the epidemiology of adult emergency department (ED) patients with non-purulent SSTIs. Methods: We performed a health records review of adults (age 18 years) with non-purulent SSTIs treated at two tertiary care EDs. Patients were excluded if they had a purulent infection or infected ulcers without surrounding cellulitis. Treatment failure was defined any of the following after a minimum of 48 hours of oral therapy: (i) hospitalization for SSTI; (ii) change in class of oral antibiotic owing to infection progression; or (iii) change to intravenous therapy owing to infection progression. Multivariable logistic regression was used to identify predictors independently associated with the primary outcome of oral antibiotic treatment failure after a minimum of 48 hours of oral therapy. Results: We enrolled 500 patients (mean age 64 years, 279 male (55.8%) and 126 (25.2%) with diabetes) and the hospital admission rate was 29.6%. The majority of patients (70.8%) received at least one intravenous antibiotic dose in the ED. Of 288 patients who had received a minimum of 48 hours of oral antibiotics, there were 85 oral antibiotic treatment failures (29.5%). Tachypnea at triage (odds ratio [OR]=6.31, 95% CI=1.80 to 22.08), chronic ulcers (OR=4.90, 95% CI=1.68 to 14.27), history of MRSA colonization or infection (OR=4.83, 95% CI=1.51 to 15.44), and cellulitis in the past 12 months (OR=2.23, 95% CI=1.01 to 4.96) were independently associated with oral antibiotic treatment failure. Conclusion: This is the first study to evaluate potential predictors of oral antibiotic treatment failure for non-purulent SSTIs in the ED. We observed a high rate of treatment failure and hospitalization. Tachypnea at triage, chronic ulcers, history of MRSA colonization or infection and cellulitis within the past year were independently associated with oral antibiotic treatment failure. Emergency physicians should consider these risk factors when deciding on oral versus intravenous antimicrobial therapy for non-purulent SSTIs being managed as outpatients.

scholarly journals Treatment Failure Outcomes for Emergency Department Patients with Skin and Soft Tissue Infections

2015 ◽  
Vol 16 (5) ◽  
pp. 642-652 ◽  
Author(s):  
Larissa May ◽  
Mark Zocchi ◽  
Catherine Zatorski ◽  
Jeanne Jordan ◽  
Richard Rothman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Treatment Failure ◽  
Soft Tissue Infections ◽  
Emergency Department Patients

scholarly journals Prevalence and predictors of initial oral antibiotic treatment failure in adult emergency department patients with cellulitis: a pilot study

BMJ Open ◽  
2015 ◽  
Vol 5 (6) ◽  
pp. e008150 ◽  
Author(s):  
Michael Quirke ◽  
Fiona Boland ◽  
Tom Fahey ◽  
Ronan O'Sullivan ◽  
Arnold Hill ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Treatment Failure ◽  
Antibiotic Treatment ◽  
Oral Antibiotic ◽  
Emergency Department Patients

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 13-14
Author(s):  
Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽  
Maryam Al Ali, MBBS
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections

2015 ◽  
Vol 49 (6) ◽  
pp. 855-863 ◽  
Author(s):  
Rakesh D. Mistry ◽  
Alexander W. Hirsch ◽  
Ashley L. Woodford ◽  
Megan Lundy
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Soft Tissue Infections ◽  
Observation Unit

scholarly journals 289. Impact of Clinician Specialty on the Use of Oral Antibiotic Therapy for Definitive Treatment of Uncomplicated Bloodstream Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S145
Author(s):  
Jasmine R Marcelin ◽  
Mackenzie R Keintz ◽  
Jihyun Ma ◽  
Erica J Stohs ◽  
Bryan Alexander ◽  
...  
Keyword(s):  
Social Media ◽  
Soft Tissue ◽  
Infectious Diseases ◽  
Antibiotic Therapy ◽  
Bloodstream Infections ◽  
Definitive Treatment ◽  
Oral Antibiotic ◽  
Soft Tissue Infections ◽  
Gram Positive ◽  
Oral Antibiotic Therapy

Abstract Background No established guidelines exist regarding the role of oral antibiotic therapy (OAT) to treat uncomplicated bloodstream infections (uBSIs) and practices may vary depending on clinician specialty and experience. Methods An IRB-exempt web-based survey was emailed to Nebraska Medicine clinicians caring for hospitalized patients, and widely disseminated using social media. The survey was open access and once disseminated on social media, it was impossible to ascertain the total number of individuals who received the survey. Chi-squared analysis for categorical data was conducted to evaluate the association between responses and demographic groups. Results Of 275 survey responses, 51% were via social media, and 94% originated in the United States. Two-thirds of respondents were physicians, 16% pharmacists, and infectious diseases clinicians (IDC) represented 71% of respondents. The syndromes where most were comfortable using OAT routinely for uBSI were urinary tract infection (92%), pneumonia (82%), pyelonephritis (82%), and skin/soft tissue infections (69%). IDC were more comfortable routinely using OAT to treat uBSIs associated with vertebral osteomyelitis and prosthetic joint infections than non-infectious diseases clinicians (NIDC), but NIDC were more likely to report comfort with routine use of OAT to treat uBSIs associated with meningitis and skin/soft tissue infections. IDC were more likely to report comfort with routine use of OAT for uBSIs due to Enterobacteriaceae and gram-positive anaerobes, while NIDC were more likely to be comfortable with routinely using OAT to treat uBSIs associated with S. aureus, coagulase-negative staphylococci and gram-positive bacilli. In one clinical vignette of S. aureus uBSI due to debrided abscess, 11% of IDC would be comfortable using OAT vs 28% of NIDC; IDC were more likely to report routinely repeating blood cultures (99% vs 83%, p< 0.05). Figure 1: Clinician comfort using oral antibiotic therapy to treat uncomplicated bacteremia due to specific syndromes Figure 2: Clinician comfort using oral antibiotic therapy to treat uncomplicated bacteremia due to specific organisms Conclusion Considerable variation in comfort using OAT for uBSIs among IDC vs NIDC exists, highlighting opportunities for IDC to continue to demonstrate their value in clinical practice. Understanding the reasons for variability may be helpful in creating best practice guidelines to standardize decision making. Disclosures All Authors: No reported disclosures

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