Antimicrobial stewardship in patients with acute bacterial skin and skin-structure infections: An international Delphi consensus

Abstract

Objectives: The aim of this survey was to identify a set of actions aimed to improve the diagnosis and management of acute bacterial skin and skin-structure infections (ABSSSIs) and the implementation of some principles of antimicrobial stewardship (AMS) in this setting.

Methods: A list of 76 statements for which there was a lack of clarity were generated by an expert panel and were validated by a group of experts. The questionnaire was administered to 112 experts in infectious diseases or microbiology. Participants were asked to vote on a list of statements. An agreement threshold of 66% was required to reach consensus.

Results: Overall, 57 responders participated in the survey. Positive consensus was reached on the fact that ABSSSIs represent a significant cause of infection in the emergency department, are frequently associated with increased hospital stay and are mainly caused by Staphylococcus aureus. The panellists strongly supported collection of samples from purulent infections by needle aspiration as well as collection of blood cultures in the presence of signs/symptoms of systemic infection. The importance of source control and prompt adequate microbiological documentation, the objective to reduce the length of hospital stay, the choice of a narrow-spectrum antibiotic and the role of new therapeutic options (e.g. long-acting drugs) in improving compliance also reached a positive consensus.

Conclusion: This Delphi survey provides useful indicators for the implementation of AMS principles in the clinical management of ABSSSI and offers interesting elements of discussion about the barriers existing in Europe for optimal implementation of AMS programmes.

Keywords: Acute bacterial skin and skin-structure infection; Antibiotic resistance; Antimicrobial stewardship; Multidrug resistance; Staphylococcus aureus.