Comparative analysis of empiric antimicrobial treatments for skin and soft tissue infections in newly hospitalized patients

Optimization of Antibiotic Selection in the Emergency Department for Adult Skin and Soft Tissue Infections

Objectives: Emergency department (ED) order sets that include skin and soft tissue infections (SSTI) stratification and antimicrobial selection criteria may improve clinical outcomes and appropriateness of initial antibiotic selection. The purpose of this study was to optimize and evaluate antimicrobial prescribing for SSTI in the ED by implementing an institution specific Infectious Diseases Society of America (IDSA) guideline directed computerized provider order entry (CPOE) order set. The primary outcome was the rate of appropriate antibiotic prescribing for SSTI in the ED before and after order set revision. Secondary outcomes were length of hospital stay, rate of continuity of antibiotics from the ED to hospital admission orders, and frequency of order set utilization. Methods: This was a single-centered, retrospective, cohort study. The ED SSTI order set revision reflected current IDSA guidelines, institution formulary, and institution antibiogram. Results: A total of 180 patients were included in the study. The rate of appropriate antibiotic prescribing was 74.4% and 78.9% (P = .60) in the pre-revision and post-revision groups, respectively. Length of hospital stay of admitted patients was 4.93 and 4.32 days (P = .61). Rate of antibiotics continued from the ED to admission was 62.1% and 59.4% (P = .99). Order set utilization was 17.8% and 24.4% (P = .36). A subgroup analysis found appropriateness increased with order set use in admitted patients (50% vs 88.2%; P = .0382) and total patients (50% vs 81.8%; P = .037). Conclusion: An order set reflective of current IDSA guidelines and institution specific antibiogram showed a similar rate of appropriate antibiotic selection compared to provider's clinical judgment. Provider awareness of SSTI management could have been a limitation to the study.

Application of external drugs comprising silver compounds for the treatment of pyodermic patients

An external anti-bacterial therapy is selected for pyodermic patients empirically. Silver sulfathiazole has an evident anti-inflammatory and anti-microbial effect against a broad range of microorganisms. Goal of the study. To assess the efficacy, safety and tolerability of a cream comprising 2% silver sulfathiazole vs. 3% tetracycline ointment for the treatment of pyodermic patients. Materials and methods. The study involved 50 pyodermic patients (at the mean age of 23.5 ± 4.1 years) including 31 (62%) male and 19 (38%) female patients. The patients were divided into two groups: Group I (n = 35) used the cream comprising 2% silver sulfathiazole while Group II (n = 15) was administered 3% tetracycline ointment. All of the patients were assessed for clinical and microbiological efficacy of the therapy. Results. The average patient recovery time in Group I amounted to 8.7 ± 0.9 days and 13.1 ± 2.7 days in Group II (р < 0.01). As many as 33 patients (94.3%) achieved clinical recovery and 2 patients (5.7%) achieved improvement by Day 10 in Group I; in Group II, clinical recovery was observed in 8 patients (53.3%), improvement - in 3 patients (20%), and no effect - in 4 patients (26.7%). Conclusion. The external anti-bacterial monotherapy of pyodermic patients with the cream comprising 2% silver sulfathiazole is more efficient than treatment with 3% tetracycline ointment. High clinical and microbiological efficacy of the cream comprising 2% silver sulfathiazole makes it possible to recommend it for empirical treatment of pyodermic patients.