• Am J Emerg Med · Aug 2021

    Controlled Clinical Trial

    A multifaceted intervention improves antibiotic stewardship for skin and soft tissues infections.

    • Larissa May, Megan H Nguyen, Renee Trajano, Daniel Tancredi, Elmar R Aliyev, Benjamin Mooso, Chance Anderson, Susan Ondak, Nuen Yang, Stuart Cohen, Jean Wiedeman, and Loren G Miller.
    • Department of Emergency Medicine, University of California, Davis, 2315 Stockton Blvd., Sacramento, CA 96817, USA. Electronic address: lsmay@ucdavis.edu.
    • Am J Emerg Med. 2021 Aug 1; 46: 374-381.

    ObjectiveAssess the effectiveness of a multifaceted stewardship intervention to reduce frequency and duration of inappropriate antibiotic use for emergency department (ED) patients with skin and soft tissue infections (SSTI). We hypothesized the antibiotic stewardship program would reduce antibiotic duration and improve guideline adherence in discharged SSTI patients.DesignNonrandomized controlled trial.SettingAcademic EDs (intervention site and control site).Patients Or ParticipantsAttending physicians and nurse practitioners at participating EDs.Intervention(S)Education regarding guideline-based treatment of SSTI, tests of antimicrobial treatment of SSTI, implementation of a clinical treatment algorithm and order set in the electronic health record, and ED clinicians' audit and feedback.ResultsWe examined 583 SSTIs. At the intervention site, clinician adherence to guidelines improved from 41% to 51% (aOR = 2.13 [95% CI: 1.20-3.79]). At the control site, there were no changes in adherence during the "intervention" period (aOR = 1.17 [0.65-2.12]). The between-site comparison of these during vs. pre-intervention odds ratios was not different (aOR = 1.82 [0.79-4.21]). Antibiotic duration decreased by 26% at the intervention site during the intervention compared to pre-intervention (Adjusted Geometric Mean Ratio [95% CI] = 0.74 [0.66-0.84]). Adherence was inversely associated with SSTI severity (severe vs mild; adjusted OR 0.42 [0.20-0.89]) and purulence (0.32 [0.21-0.47]). Mean antibiotic prescription duration was 1.95 days shorter (95% CI: 1.54-2.33) in the time period following the intervention than pre-intervention period.ConclusionsA multifaceted intervention resulted in modest improvement in adherence to guidelines compared to a control site, driven by treatment duration reductions.Copyright © 2020 Elsevier Inc. All rights reserved.

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