Cargando…

564. Patient and Prescriber Characteristics Associated with Inappropriately Long Antibiotic Duration for Skin and Soft Tissue Infections

BACKGROUND: For common infections, previous studies suggest more seasoned prescribers more commonly use inappropriately long antibiotic durations however, there is a paucity of data regarding patient and provider factors associated with antibiotic prescription duration for pediatric skin and soft ti...

Descripción completa

Detalles Bibliográficos
Autores principales: Broussard, Kali, Watson, Joshua R, Stevens, Jack, Chaparro, Juan D, Abdel-Rasoul, Mahmoud
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752378/
http://dx.doi.org/10.1093/ofid/ofac492.617
_version_ 1784850707487129600
author Broussard, Kali
Watson, Joshua R
Stevens, Jack
Chaparro, Juan D
Abdel-Rasoul, Mahmoud
author_facet Broussard, Kali
Watson, Joshua R
Stevens, Jack
Chaparro, Juan D
Abdel-Rasoul, Mahmoud
author_sort Broussard, Kali
collection PubMed
description BACKGROUND: For common infections, previous studies suggest more seasoned prescribers more commonly use inappropriately long antibiotic durations however, there is a paucity of data regarding patient and provider factors associated with antibiotic prescription duration for pediatric skin and soft tissue (SSTI). METHODS: Retrospective analysis of patients age 0-21 years prescribed enteral antibiotics for cellulitis, abscess, impetigo, or other SSTI in one of 13 Nationwide Children’s Hospital’s primary care clinics in 2020. Encounters for paronychia, facial abscess, and immunocompromised patients were excluded. Based on national and local SSTI guidelines, antibiotic duration was considered inappropriately long if >5 days for cellulitis or drained abscess or >7 days for undrained abscess, impetigo, or other SSTI. Patient and prescriber factors were collected (Table 1) then univariate and multivariable analyses performed to determine which factors were associated with long antibiotic duration. Statistical analyses accounted for within prescriber correlation. RESULTS: From 1/1/2020 to 12/31/2020, we identified 1248 encounters for SSTI. After exclusions, 577 encounters with enteral prescriptions written by 89 prescribers were analyzed. Patient age ranged from 11 days to 20 years, 314 (54%) were female, and 497 (86%) had public insurance. The most common diagnosis was impetigo in 165 (29%). Similar rates of long duration were seen across patients of all ages and insurance categories. No difference in prescriber degree type was associated with antibiotic duration. Mean years since completion of medical training for prescribers of long vs guideline concordant prescriptions was 13 vs 10 in univariate analysis (p=.001). In the multivariable analysis, only diagnosis was associated with increased odds of long duration (Table 2). Compared to impetigo, the adjusted odds ratio for inappropriately long duration was 9.36 for cellulitis and 2.03 for abscess. Patient and Prescriber Characteristics for SSTI Antibiotic Prescriptions [Figure: see text] IQR, interquartile range, MD, Doctor of Medicine, DO, Doctor of Osteopathic Medicine, NP, Nurse Practitioner †Mann Whitney ‡Fisher’s exact *Chi-square ¶N=556 due to missing data for 21 encounters Multivariable Analysis of Patient and Provider Factors and Inappropriately Long Antibiotic Duration for SSTI [Figure: see text] Multivariable Analysis of Patient and Provider Factors and adjusted odds ratios for inappropriately long antibiotic duration. *Unknown insurance type for 24 encounters †Missing data for 21 encounters CONCLUSION: In this study of antibiotic duration for SSTI, diagnosis of cellulitis was most strongly associated with inappropriately long duration- providing a focus for future stewardship efforts. Contrary to prior studies, no other patient or provider factor was associated with long duration in our pediatric primary care network. DISCLOSURES: Jack Stevens, PhD, Colgate Palmolive (although this abstract does not pertain to any products/services of that highly diversified company): Stocks/Bonds|Procter and Gamble (although this abstract does not pertain to any products/services of that highly diversiified company): Stocks/Bonds.
format Online
Article
Text
id pubmed-9752378
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-97523782022-12-16 564. Patient and Prescriber Characteristics Associated with Inappropriately Long Antibiotic Duration for Skin and Soft Tissue Infections Broussard, Kali Watson, Joshua R Stevens, Jack Chaparro, Juan D Abdel-Rasoul, Mahmoud Open Forum Infect Dis Abstracts BACKGROUND: For common infections, previous studies suggest more seasoned prescribers more commonly use inappropriately long antibiotic durations however, there is a paucity of data regarding patient and provider factors associated with antibiotic prescription duration for pediatric skin and soft tissue (SSTI). METHODS: Retrospective analysis of patients age 0-21 years prescribed enteral antibiotics for cellulitis, abscess, impetigo, or other SSTI in one of 13 Nationwide Children’s Hospital’s primary care clinics in 2020. Encounters for paronychia, facial abscess, and immunocompromised patients were excluded. Based on national and local SSTI guidelines, antibiotic duration was considered inappropriately long if >5 days for cellulitis or drained abscess or >7 days for undrained abscess, impetigo, or other SSTI. Patient and prescriber factors were collected (Table 1) then univariate and multivariable analyses performed to determine which factors were associated with long antibiotic duration. Statistical analyses accounted for within prescriber correlation. RESULTS: From 1/1/2020 to 12/31/2020, we identified 1248 encounters for SSTI. After exclusions, 577 encounters with enteral prescriptions written by 89 prescribers were analyzed. Patient age ranged from 11 days to 20 years, 314 (54%) were female, and 497 (86%) had public insurance. The most common diagnosis was impetigo in 165 (29%). Similar rates of long duration were seen across patients of all ages and insurance categories. No difference in prescriber degree type was associated with antibiotic duration. Mean years since completion of medical training for prescribers of long vs guideline concordant prescriptions was 13 vs 10 in univariate analysis (p=.001). In the multivariable analysis, only diagnosis was associated with increased odds of long duration (Table 2). Compared to impetigo, the adjusted odds ratio for inappropriately long duration was 9.36 for cellulitis and 2.03 for abscess. Patient and Prescriber Characteristics for SSTI Antibiotic Prescriptions [Figure: see text] IQR, interquartile range, MD, Doctor of Medicine, DO, Doctor of Osteopathic Medicine, NP, Nurse Practitioner †Mann Whitney ‡Fisher’s exact *Chi-square ¶N=556 due to missing data for 21 encounters Multivariable Analysis of Patient and Provider Factors and Inappropriately Long Antibiotic Duration for SSTI [Figure: see text] Multivariable Analysis of Patient and Provider Factors and adjusted odds ratios for inappropriately long antibiotic duration. *Unknown insurance type for 24 encounters †Missing data for 21 encounters CONCLUSION: In this study of antibiotic duration for SSTI, diagnosis of cellulitis was most strongly associated with inappropriately long duration- providing a focus for future stewardship efforts. Contrary to prior studies, no other patient or provider factor was associated with long duration in our pediatric primary care network. DISCLOSURES: Jack Stevens, PhD, Colgate Palmolive (although this abstract does not pertain to any products/services of that highly diversified company): Stocks/Bonds|Procter and Gamble (although this abstract does not pertain to any products/services of that highly diversiified company): Stocks/Bonds. Oxford University Press 2022-12-15 /pmc/articles/PMC9752378/ http://dx.doi.org/10.1093/ofid/ofac492.617 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Broussard, Kali
Watson, Joshua R
Stevens, Jack
Chaparro, Juan D
Abdel-Rasoul, Mahmoud
564. Patient and Prescriber Characteristics Associated with Inappropriately Long Antibiotic Duration for Skin and Soft Tissue Infections
title 564. Patient and Prescriber Characteristics Associated with Inappropriately Long Antibiotic Duration for Skin and Soft Tissue Infections
title_full 564. Patient and Prescriber Characteristics Associated with Inappropriately Long Antibiotic Duration for Skin and Soft Tissue Infections
title_fullStr 564. Patient and Prescriber Characteristics Associated with Inappropriately Long Antibiotic Duration for Skin and Soft Tissue Infections
title_full_unstemmed 564. Patient and Prescriber Characteristics Associated with Inappropriately Long Antibiotic Duration for Skin and Soft Tissue Infections
title_short 564. Patient and Prescriber Characteristics Associated with Inappropriately Long Antibiotic Duration for Skin and Soft Tissue Infections
title_sort 564. patient and prescriber characteristics associated with inappropriately long antibiotic duration for skin and soft tissue infections
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752378/
http://dx.doi.org/10.1093/ofid/ofac492.617
work_keys_str_mv AT broussardkali 564patientandprescribercharacteristicsassociatedwithinappropriatelylongantibioticdurationforskinandsofttissueinfections
AT watsonjoshuar 564patientandprescribercharacteristicsassociatedwithinappropriatelylongantibioticdurationforskinandsofttissueinfections
AT stevensjack 564patientandprescribercharacteristicsassociatedwithinappropriatelylongantibioticdurationforskinandsofttissueinfections
AT chaparrojuand 564patientandprescribercharacteristicsassociatedwithinappropriatelylongantibioticdurationforskinandsofttissueinfections
AT abdelrasoulmahmoud 564patientandprescribercharacteristicsassociatedwithinappropriatelylongantibioticdurationforskinandsofttissueinfections