Abstract
Background
Infectious Diseases Society of America guidelines recommend that patients hospitalized
for acute bacterial skin infections after failure of outpatient antibiotic therapy
be managed as “severe” infections; however, the clinical relevance of apparent failure
of outpatient therapy is not clear.
Methods
This was a secondary analysis of a multicenter, retrospective cohort of adults and
children hospitalized for cellulitis, abscess, or wound infection. We compared clinical
features, laboratory and microbiology findings, antibiotic treatment, and outcomes
among patients who received outpatient antibiotics prior to admission and those who
did not.
Results
Of 533 patients, 179 (34%) received outpatient antibiotics prior to admission. Compared
with those who did not, patients who received antibiotics prior to admission less
frequently had fever (18% vs 26%, P = .04) and leukocytosis (33% vs 51%, P < .001). In the 202 cases where a microorganism was identified, Staphylococcus aureus was more common among those who received antibiotics prior to admission (75% vs 58%,
P = .02), particularly methicillin-resistant S aureus (41% vs 27%, P = .049), whereas aerobic gram-negative bacilli were less common (3% vs 13%, P = .03). After hospitalization, clinical failure occurred with similar frequency between
the 2 groups (12% vs 11%, P = .73).
Conclusions
Patients hospitalized with skin infections after apparently failing outpatient therapy
had clinical features suggestive of less severe infection and similar outcomes compared
with patients who did not receive antibiotics prior to admission. Our results suggest
that inpatient treatment for patients not responding to outpatient therapy should
focus on methicillin-resistant S aureus, not gram-negative pathogens.
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Article Info
Publication History
Published online: February 11, 2016
Accepted:
February 9,
2016
Received in revised form:
February 8,
2016
Received:
February 1,
2016
Footnotes
☆Funding: National Institute of Allergy and Infectious Diseases, National Institutes of Health ( K23 AI099082 ). The sponsor had no role in the design of the study, data collection, the analysis and interpretation of data, the writing of the report, or the decision to submit the manuscript for publication.
☆☆Potential conflicts of interest: T.C.J.: Durata Therapeutics; D.M.P.: Optimer, Cubist, and Forest Pharmaceuticals. All other authors have no conflicts of interest to disclose.
★Prior presentations: None.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
