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Outpatient antimicrobial stewardship targets for treatment of skin and soft-tissue infections

Published online by Cambridge University Press:  02 July 2018

Preeti Jaggi ,
Ling Wang ,
Sean Gleeson ,
Melissa Moore-Clingenpeel  and
Joshua R. Watson
Preeti Jaggi*
Affiliation:
Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
Ling Wang
Affiliation:
Nationwide Children’s Hospital, Partners for Kids, Columbus, Ohio
Sean Gleeson
Affiliation:
Department of Pediatrics, The Ohio State University, Nationwide Children’s Hospital, Partners for Kids, Columbus, Ohio
Melissa Moore-Clingenpeel
Affiliation:
Biostatistics Core, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
Joshua R. Watson*
Affiliation:
Department of Pediatrics, The Ohio State University, Nationwide Children’s Hospital, Partners for Kids, Columbus, Ohio
*
Author for correspondence: Preeti Jaggi, MD, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, NE, Rm. 504A, Atlanta, GA, 30322. E-mail: preeti.jaggi@emory.edu or Joshua R. Watson, MD, Division of Infectious Diseases, Department of Pediatrics, The Ohio State University, Nationwide Children’s Hospital, Partners for Kids, 700 Children’s Drive, Columbus, OH 43205. E-mail: joshua.watson@nationwidechildrens.org
Author for correspondence: Preeti Jaggi, MD, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, NE, Rm. 504A, Atlanta, GA, 30322. E-mail: preeti.jaggi@emory.edu or Joshua R. Watson, MD, Division of Infectious Diseases, Department of Pediatrics, The Ohio State University, Nationwide Children’s Hospital, Partners for Kids, 700 Children’s Drive, Columbus, OH 43205. E-mail: joshua.watson@nationwidechildrens.org
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Abstract

Objective

We sought to identify factors associated with long duration and/or non–first-line choice of treatment for pediatric skin and soft-tissue infections (SSTIs).

Design

Retrospective cohort study.

Setting

Ambulatory encounter claims of Medicaid-insured children lacking chronic medical conditions treated for SSTI and/or animal bite injury in Ohio in 2014.

Methods

For all diagnoses, long treatment duration was defined as treatment >7 days. Non–first-line choice of treatment for SSTI included treatment with 2 antimicrobials dispensed on the same calendar day or any treatment not listed in the Infectious Diseases Society of America guidelines. The adjusted odds of (1) long treatment duration and (2) non–first-line choice of treatment were calculated for patient age, prescriber type, and patient county of residence characteristics (ie, rural vs metropolitan area and poverty rate).

Results

Of 10,310 encounters with complete data available, long treatment duration was prescribed in 7,968 (77.3%). The most common duration of treatment prescribed was 10 days. A non–first-line choice was prescribed in 1,030 encounters (10%). Dispensation of 2 antimicrobials on the same calendar day was the most common reason for the non–first-line choice, and of these, trimethoprim-sulfamethoxazole plus a first-generation cephalosporin was the most common regimen. Compared to pediatricians, the adjusted odds ratio of long treatment duration was significantly lower for all other primary care specialties. Conversely, nonpediatricians were more likely to prescribe a non–first-line treatment choice. Patient residence in a high-poverty county increased the odds of both long duration and non–first-line choice of treatment.

Conclusions

Healthcare claims may be utilized to measure opportunities for first-line choice and/or shorter duration of treatment for SSTI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 8 , August 2018 , pp. 936 - 940
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

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