Show simple item record

dc.contributor.authorHaran, John P
dc.contributor.authorWilsterman, E.
dc.contributor.authorZeoli, T.
dc.contributor.authorGoulding, Melissa
dc.contributor.authorMcLendon, Emily
dc.contributor.authorClark, Melissa A.
dc.date2022-08-11T08:10:35.000
dc.date.accessioned2022-08-23T17:13:38Z
dc.date.available2022-08-23T17:13:38Z
dc.date.issued2018-12-05
dc.date.submitted2019-01-23
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.issn0950-2688 (Linking)
dc.identifier.doi10.1017/S0950268818003291
dc.identifier.pmid30516120
dc.identifier.urihttp://hdl.handle.net/20.500.14038/46775
dc.description.abstractThe 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.isoen_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.rightsCOPYRIGHT: © 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.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectAntibiotics
dc.subjectelderly
dc.subjectinfectious disease
dc.subjectskin infections
dc.subjectBacterial Infections and Mycoses
dc.subjectClinical Epidemiology
dc.subjectEmergency Medicine
dc.subjectEpidemiology
dc.subjectGeriatrics
dc.subjectHealth Services Administration
dc.subjectInfectious Disease
dc.subjectSkin and Connective Tissue Diseases
dc.titleDeviating from IDSA treatment guidelines for non-purulent skin infections increases the risk of treatment failure in emergency department patients
dc.typeJournal Article
dc.source.journaltitleEpidemiology and infection
dc.source.volume147
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=2237&amp;context=qhs_pp&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/1235
dc.identifier.contextkey13667582
refterms.dateFOA2022-08-23T17:13:39Z
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.submissionpathqhs_pp/1235
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.contributor.departmentDepartment of Emergency Medicine
dc.source.pagese68


Files in this item

Thumbnail
Name:
deviating_from_idsa_treatment_ ...
Size:
216.6Kb
Format:
PDF

This item appears in the following Collection(s)

Show simple item record

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.
Except where otherwise noted, this item's license is described as 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.