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Patterns of Initial Antibiotic Therapy for Complicated Skin and Skin Structure Infections (cSSSI) in US Hospitals, 2000–2009

Berger, Ariel MPH*; Edelsberg, John MD, MPH*; Oster, Gerry PhD*; Huang, Xingyue BPharm, PhD; Weber, David J. MD, MPH

Infectious Diseases in Clinical Practice: May 2013 - Volume 21 - Issue 3 - p 159–167
doi: 10.1097/IPC.0b013e318279ee69
Original Articles

Background: Complicated skin and skin structure infections (cSSSIs) result in more than 1 million hospitalizations annually in the United States. Whereas cSSSI treatment guidelines have changed over time, changes in initial antibiotic therapy have not been well described.

Methods: We examined admission records from approximately 100 US hospitals over the period January 1, 2000, to June 30, 2009, to characterize changes in initial antibiotic therapy in patients aged 18 years or older who were hospitalized for cSSSI. Initial antibiotic therapy was defined as all parenteral antibiotics received within 24 hours of admission. Statistical significance of changes in therapy was ascertained using 2-tailed χ2 tests.

Results: The study sample consisted of 22,382 patients hospitalized for cSSSI; most (75%) had acute infections (18%, surgical-site; and 7%, chronic/ulcerative). The use of cefazolin as initial therapy (either alone or as part of a multi-drug regimen) declined markedly, from 32% of all cSSSI admissions in 2000 to 11% in 2009, as did the use of ampicillin-sulbactam (26% to 10%) (both P < 0.01). The use of agents with activity against methicillin-resistant Staphylococcus aureus increased from 30% of all cSSSI admissions in 2000 to 71% in 2009, reflecting an increased use of vancomycin (20% to 58%); the use of agents with activity against Pseudomonas aeruginosa also increased (16% to 28%) (all P < 0.01).

Conclusions: Initial antibiotic therapy for cSSSI has changed substantially in the United States over the past decade, most likely owing to growing concerns about antimicrobial resistance and revised treatment guidelines.

A review of admission records from approximately 100 US hospitals reveals that patterns of initial antibiotic therapy for cSSSI have changed substantially over the period, 2000–2009—most notably, initial use of antibiotic agents with activity against methicillin-resistant Staphylococcus aureus (MRSA) has more than doubled.

From the *Policy Analysis Inc (PAI), Brookline, MA; †Forest Research Institute, Inc, Jersey City, NJ and ‡University of North Carolina School of Medicine, Chapel Hill, NC.

Correspondence to: Ariel Berger, MPH, Policy Analysis Inc (PAI), 4 Davis Ct, Brookline, MA 02445. E-mail: aberger@pai.com.

Dr. Oster, Mr. Berger, and Dr. Edelsberg are employed by Policy Analysis Inc (PAI), which received funding from Forest Research Institute for the work described herein. Dr. Oster, Mr. Berger, and Dr. Edelsberg have no other relationships, conditions, and/or circumstances that present a potential conflict of interest. Dr. Weber was engaged as an independent consultant to PAI on this study. Dr. Weber has (1) held consultancy positions with, and received lecture fees from, Merck, Pfizer, and Clorox; (2) provided expert testimony in lawsuits unrelated to the work described herein; (3) received grants from the CDC and NIH; and (4) received payment from the Association of Perioperative Nurses (AORN) for the development of educational presentations on hand hygiene. Dr. Weber also is an associate editor of Infection Control and Hospital Epidemiology. Dr. Weber has no other relationships, conditions, and/or circumstances that present a potential conflict of interest. Dr. Huang is an employee of Forest Laboratories, Inc.

Funding for this research was provided by Forest Research Institute.

© 2013 by Lippincott Williams & Wilkins.