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Walsh TL, Bhanot N, Murillo MA, Uchin JM, Min Z. Creeping Skin Lesions: Primary Cutaneous Cryptococcosis. Am J Med 2017; 130:666-668. [PMID: 28223065 DOI: 10.1016/j.amjmed.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Thomas L Walsh
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa.
| | - Nitin Bhanot
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa
| | - Monika A Murillo
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa
| | - Jeffrey M Uchin
- Department of Pathology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa
| | - Zaw Min
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa
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Walsh TL, Bremmer DN, Moffa MA, Chan-Tompkins NH, Murillo MA, Chan L, Burkitt MJ, Konopka CI, Watson C, Trienski TL. Effect of Antimicrobial Stewardship Program Guidance on the Management of Uncomplicated Skin and Soft Tissue Infections in Hospitalized Adults. Mayo Clin Proc Innov Qual Outcomes 2017; 1:91-99. [PMID: 30225405 PMCID: PMC6135010 DOI: 10.1016/j.mayocpiqo.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To assess the effect of an antimicrobial stewardship program (ASP)–bundled initiative on the appropriate use of antibiotics for uncomplicated skin and soft tissue infections (uSSTIs) at 2 academic medical centers in Pittsburgh, Pennsylvania. Patients and Methods A retrospective preintervention and postintervention study was conducted to compare management of patients admitted with uSSTIs before and after the implementation of the bundled initiative. The preintervention period was from August 1, 2014, through March 31, 2015, and the postintervention period was from August 1, 2015, through March 31, 2016. Results A total of 160 patients were included in the preintervention cohort, and 163 were included in the postintervention cohort. Compared with the preintervention group, the mean duration of therapy decreased (12.5 days vs 8.8 days; P<.001) and an appropriate duration of less than 10 days increased in more patients (20.6% [33 of 160] vs 68.7% [112 of 163]; P<.001) in the postintervention period. Fewer patients were exposed to antimicrobials with extended gram-negative (44.4% [71 of 160] vs 9.2% [15 of 163]; P<.001), anaerobic (39.4% [63 of 160] vs 9.8% [16 of 163]; P<.001), and antipseudomonal (16.3% [26 of 160] vs 1.8% [3 of 163]; P<.001) coverage. The mean length of stay decreased from 3.6 to 2.2 days (P<.001) without an increase in 30-day readmissions (6.3% [10 of 160] vs 4.9% [8 of 163]; P=.64). The ASP made recommendations for 125 patients, and 96% were accepted. Conclusion Implementation of an ASP-bundled approach aimed at optimizing antibiotic therapy in the management of uSSTIs led to shorter durations of narrow-spectrum therapy as well as shorter hospital length of stay without adversely affecting hospital readmissions.
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Key Words
- AGH, Allegheny General Hospital
- ASP, antimicrobial stewardship program
- ICD-10, International Classification of Diseases, Tenth Revision
- ICD-9, International Classification of Diseases, Ninth Revision
- IDSA, Infectious Diseases Society of America
- SSTI, skin and soft tissue infection
- WPH, Western Pennsylvania Hospital
- uSSTI, uncomplicated skin and skin tissue infection
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Affiliation(s)
- Thomas L Walsh
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA.,Division of Infectious Diseases, Department of Medicine, Western Pennsylvania Hospital, Pittsburgh, PA
| | - Derek N Bremmer
- Department of Pharmacy, Western Pennsylvania Hospital, Pittsburgh, PA
| | - Matthew A Moffa
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA.,Division of Infectious Diseases, Department of Medicine, Western Pennsylvania Hospital, Pittsburgh, PA
| | - Noreen H Chan-Tompkins
- Department of Pharmacy, Allegheny General Hospital, Pittsburgh, PA.,School of Pharmacy, Loma Linda University, Loma Linda, CA
| | - Monika A Murillo
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA.,Division of Infectious Diseases, Department of Medicine, Western Pennsylvania Hospital, Pittsburgh, PA
| | - Lynn Chan
- Department of Pharmacy, Allegheny General Hospital, Pittsburgh, PA.,Department of Pharmacy, Mayo Clinic, Phoenix, AZ
| | - Michael J Burkitt
- Division of Hospital Medicine, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA.,Division of Hospital Medicine, Department of Medicine, Western Pennsylvania Hospital, Pittsburgh, PA
| | | | - Courtney Watson
- Center for Inclusion Health, Allegheny General Hospital, Pittsburgh, PA
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Walsh TL, Chan L, Konopka CI, Burkitt MJ, Moffa MA, Bremmer DN, Murillo MA, Watson C, Chan-Tompkins NH. Appropriateness of antibiotic management of uncomplicated skin and soft tissue infections in hospitalized adult patients. BMC Infect Dis 2016; 16:721. [PMID: 27899072 PMCID: PMC5129241 DOI: 10.1186/s12879-016-2067-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/25/2016] [Indexed: 11/23/2022] Open
Abstract
Background Skin and soft tissue infections (SSTIs) are a leading cause for hospitalizations in the United States. Few studies have addressed the appropriateness of antibiotic therapy in the management of SSTIs without complicating factors. We aimed to determine the appropriateness of antibiotic treatment duration for hospitalized adult patients with uncomplicated SSTIs. Methods This was a retrospective analysis performed at two academic medical centers in Pittsburgh, Pennsylvania on patients aged 18 years and older with primary ICD-9 code for SSTIs admitted August 1st, 2014–March 31st, 2015. The primary outcome was the appropriateness of antibiotic treatment duration for uncomplicated SSTIs. Secondary objectives included the appropriateness of antibiotic agent spectrum, duration of inpatient length of stay (LOS), utilization of blood cultures and advanced imaging modalities, and re-hospitalization for SSTI within 30 days of discharge from the index admission. Results A total of 163 episodes were included in the cohort. The mean duration of total antibiotic therapy was 12.6 days. Appropriate duration was defined as receipt of total antibiotic duration of less than 10 days and occurred in 20.2% of patients. Twenty eight percent of patients received antibiotics for greater than 14 days. Seventy three (44.8%) patients received greater than 24 h of inappropriate extended spectrum gram-negative coverage; 65 (39.9%) received anaerobic coverage. Conclusions In the majority of patients, treatment duration was excessive. Inappropriate broad spectrum antibiotic selection was utilized with regularity for SSTIs without complicating factors. The management of uncomplicated SSTIs represents a significant opportunity for antimicrobial stewardship.
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Affiliation(s)
- Thomas L Walsh
- Department of Medicine and Division of Infectious Diseases, Allegheny General Hospital, 320 East North Ave. East Wing Office Building, Suite 406, Pittsburgh, PA, 15212, USA. .,Department of Medicine and Division of Infectious Diseases, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA.
| | - Lynn Chan
- Department of Pharmacy, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Chelsea I Konopka
- Department of Pharmacy, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Michael J Burkitt
- Division of Hospital Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA.,Division of Hospital Medicine, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA
| | - Matthew A Moffa
- Department of Medicine and Division of Infectious Diseases, Allegheny General Hospital, 320 East North Ave. East Wing Office Building, Suite 406, Pittsburgh, PA, 15212, USA.,Department of Medicine and Division of Infectious Diseases, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA
| | - Derek N Bremmer
- Department of Pharmacy, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA
| | - Monika A Murillo
- Department of Medicine and Division of Infectious Diseases, Allegheny General Hospital, 320 East North Ave. East Wing Office Building, Suite 406, Pittsburgh, PA, 15212, USA.,Department of Medicine and Division of Infectious Diseases, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA
| | - Courtney Watson
- Center for Inclusion Health, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Noreen H Chan-Tompkins
- Department of Pharmacy, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA
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