Deviating from IDSA treatment guidelines for non-purulent skin infections increases the risk of treatment failure in emergency department patients
dc.contributor.author | Haran, John P | |
dc.contributor.author | Wilsterman, E. | |
dc.contributor.author | Zeoli, T. | |
dc.contributor.author | Goulding, Melissa | |
dc.contributor.author | McLendon, Emily | |
dc.contributor.author | Clark, Melissa A. | |
dc.date | 2022-08-11T08:10:35.000 | |
dc.date.accessioned | 2022-08-23T17:13:38Z | |
dc.date.available | 2022-08-23T17:13:38Z | |
dc.date.issued | 2018-12-05 | |
dc.date.submitted | 2019-01-23 | |
dc.identifier.citation | <p>Epidemiol Infect. 2018 Dec 5;147:e68. doi: 10.1017/S0950268818003291. <a href="https://doi.org/10.1017/S0950268818003291">Link to article on publisher's site</a></p> | |
dc.identifier.issn | 0950-2688 (Linking) | |
dc.identifier.doi | 10.1017/S0950268818003291 | |
dc.identifier.pmid | 30516120 | |
dc.identifier.uri | http://hdl.handle.net/20.500.14038/46775 | |
dc.description.abstract | The Infectious Disease Society of America (IDSA) publishes guidelines regularly for the management of skin and soft tissue infections; however, the extent to which practice patterns follow these guidelines and if this can affect treatment failure rates is unknown. We observed the treatment failure rates from a multicentre retrospective ambulatory cohort of adult emergency department patients treated for a non-purulent skin infection. We used multivariable logistic regression to examine the role of IDSA classification and whether adherence to IDSA guidelines reduced treatment failure. A total of 759 ambulatory patients were included in the cohort with 17.4% failing treatment. Among all patients, 56.0% had received treatments matched to the IDSA guidelines with 29.1% over-treated, and 14.9% under-treated based on the guidelines. After adjustment for age, gender, infection location and medical comorbidities, patients with a moderate infection type had three times increased risk of treatment failure (adjusted risk ratio (aRR) 2.98; 95% confidence interval (CI) 1.15-7.74) and two times increased risk with a severe infection type (aRR 2.27; 95% CI 1.25-4.13) compared with mild infection types. Patients who were under-treated based on IDSA guidelines were over two times more likely to fail treatment (aRR 2.65; 95% CI 1.16-6.05) while over-treatment was not associated with treatment failure. Patients 70 years of age had a 56% increased risk of treatment failure (aRR 1.56; 95% CI 1.04-2.33) compared with those < 70 years. Following the IDSA guidelines for non-purulent SSTIs may reduce the treatment failure rates; however, older adults still carry an increased risk of treatment failure. | |
dc.language.iso | en_US | |
dc.relation | <p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=30516120&dopt=Abstract">Link to Article in PubMed</a></p> | |
dc.rights | COPYRIGHT: © The Author(s) 2018. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. | |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | |
dc.subject | Antibiotics | |
dc.subject | elderly | |
dc.subject | infectious disease | |
dc.subject | skin infections | |
dc.subject | Bacterial Infections and Mycoses | |
dc.subject | Clinical Epidemiology | |
dc.subject | Emergency Medicine | |
dc.subject | Epidemiology | |
dc.subject | Geriatrics | |
dc.subject | Health Services Administration | |
dc.subject | Infectious Disease | |
dc.subject | Skin and Connective Tissue Diseases | |
dc.title | Deviating from IDSA treatment guidelines for non-purulent skin infections increases the risk of treatment failure in emergency department patients | |
dc.type | Journal Article | |
dc.source.journaltitle | Epidemiology and infection | |
dc.source.volume | 147 | |
dc.identifier.legacyfulltext | https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=2237&context=qhs_pp&unstamped=1 | |
dc.identifier.legacycoverpage | https://escholarship.umassmed.edu/qhs_pp/1235 | |
dc.identifier.contextkey | 13667582 | |
refterms.dateFOA | 2022-08-23T17:13:39Z | |
html.description.abstract | <p>The Infectious Disease Society of America (IDSA) publishes guidelines regularly for the management of skin and soft tissue infections; however, the extent to which practice patterns follow these guidelines and if this can affect treatment failure rates is unknown. We observed the treatment failure rates from a multicentre retrospective ambulatory cohort of adult emergency department patients treated for a non-purulent skin infection. We used multivariable logistic regression to examine the role of IDSA classification and whether adherence to IDSA guidelines reduced treatment failure. A total of 759 ambulatory patients were included in the cohort with 17.4% failing treatment. Among all patients, 56.0% had received treatments matched to the IDSA guidelines with 29.1% over-treated, and 14.9% under-treated based on the guidelines. After adjustment for age, gender, infection location and medical comorbidities, patients with a moderate infection type had three times increased risk of treatment failure (adjusted risk ratio (aRR) 2.98; 95% confidence interval (CI) 1.15-7.74) and two times increased risk with a severe infection type (aRR 2.27; 95% CI 1.25-4.13) compared with mild infection types. Patients who were under-treated based on IDSA guidelines were over two times more likely to fail treatment (aRR 2.65; 95% CI 1.16-6.05) while over-treatment was not associated with treatment failure. Patients 70 years of age had a 56% increased risk of treatment failure (aRR 1.56; 95% CI 1.04-2.33) compared with those < 70 years. Following the IDSA guidelines for non-purulent SSTIs may reduce the treatment failure rates; however, older adults still carry an increased risk of treatment failure.</p> | |
dc.identifier.submissionpath | qhs_pp/1235 | |
dc.contributor.department | Department of Quantitative Health Sciences | |
dc.contributor.department | Department of Emergency Medicine | |
dc.source.pages | e68 |