Effect of Antimicrobial Stewardship Program Guidance on the Management of Uncomplicated Skin and Soft Tissue Infections in Hospitalized Adults

Thomas L Walsh; Derek N Bremmer; Matthew A Moffa; Noreen H Chan-Tompkins; Monika A Murillo; Lynn Chan; Michael J Burkitt; Chelsea I Konopka; Courtney Watson; Tamara L Trienski

doi:10.1016/j.mayocpiqo.2017.04.002

Effect of Antimicrobial Stewardship Program Guidance on the Management of Uncomplicated Skin and Soft Tissue Infections in Hospitalized Adults

Mayo Clin Proc Innov Qual Outcomes. 2017 Apr 28;1(1):91-99. doi: 10.1016/j.mayocpiqo.2017.04.002. eCollection 2017 Jul.

Authors

Thomas L Walsh^{1

2}, Derek N Bremmer³, Matthew A Moffa^{1

2}, Noreen H Chan-Tompkins^{4

5}, Monika A Murillo^{1

2}, Lynn Chan^{4

6}, Michael J Burkitt^{7

8}, Chelsea I Konopka⁴, Courtney Watson⁹, Tamara L Trienski⁴

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA.
² Division of Infectious Diseases, Department of Medicine, Western Pennsylvania Hospital, Pittsburgh, PA.
³ Department of Pharmacy, Western Pennsylvania Hospital, Pittsburgh, PA.
⁴ Department of Pharmacy, Allegheny General Hospital, Pittsburgh, PA.
⁵ School of Pharmacy, Loma Linda University, Loma Linda, CA.
⁶ Department of Pharmacy, Mayo Clinic, Phoenix, AZ.
⁷ Division of Hospital Medicine, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA.
⁸ Division of Hospital Medicine, Department of Medicine, Western Pennsylvania Hospital, Pittsburgh, PA.
⁹ Center for Inclusion Health, Allegheny General Hospital, Pittsburgh, PA.

Abstract

Objective: To assess the effect of an antimicrobial stewardship program (ASP)-bundled initiative on the appropriate use of antibiotics for uncomplicated skin and soft tissue infections (uSSTIs) at 2 academic medical centers in Pittsburgh, Pennsylvania.

Patients and methods: A retrospective preintervention and postintervention study was conducted to compare management of patients admitted with uSSTIs before and after the implementation of the bundled initiative. The preintervention period was from August 1, 2014, through March 31, 2015, and the postintervention period was from August 1, 2015, through March 31, 2016.

Results: A total of 160 patients were included in the preintervention cohort, and 163 were included in the postintervention cohort. Compared with the preintervention group, the mean duration of therapy decreased (12.5 days vs 8.8 days; P<.001) and an appropriate duration of less than 10 days increased in more patients (20.6% [33 of 160] vs 68.7% [112 of 163]; P<.001) in the postintervention period. Fewer patients were exposed to antimicrobials with extended gram-negative (44.4% [71 of 160] vs 9.2% [15 of 163]; P<.001), anaerobic (39.4% [63 of 160] vs 9.8% [16 of 163]; P<.001), and antipseudomonal (16.3% [26 of 160] vs 1.8% [3 of 163]; P<.001) coverage. The mean length of stay decreased from 3.6 to 2.2 days (P<.001) without an increase in 30-day readmissions (6.3% [10 of 160] vs 4.9% [8 of 163]; P=.64). The ASP made recommendations for 125 patients, and 96% were accepted.

Conclusion: Implementation of an ASP-bundled approach aimed at optimizing antibiotic therapy in the management of uSSTIs led to shorter durations of narrow-spectrum therapy as well as shorter hospital length of stay without adversely affecting hospital readmissions.

Keywords: AGH, Allegheny General Hospital; ASP, antimicrobial stewardship program; ICD-10, International Classification of Diseases, Tenth Revision; ICD-9, International Classification of Diseases, Ninth Revision; IDSA, Infectious Diseases Society of America; SSTI, skin and soft tissue infection; WPH, Western Pennsylvania Hospital; uSSTI, uncomplicated skin and skin tissue infection.