The Antibiotic Crisis: Can We Reverse 65 Years of Failed Stewardship? Comment on “Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess” The Antibiotic Crisis

Spellberg B. — Mon, 27 Jun 2011 00:00:00 GMT

Society is in the midst of 2 converging public health crises: skyrocketing antibiotic resistance and plummeting new antibiotic development. While most physicians have become familiar with the crisis of antibiotic resistance, few may be aware of the severity of the collapse in antibiotic development (Figure).

Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess Antibiotics and Cellulitis and Cutaneous Abscess

Jenkins TC, Knepper BC, Sabel AL, et al. — Mon, 27 Jun 2011 00:00:00 GMT

Background

Cellulitis and cutaneous abscess are among the most common infections leading to hospitalization, yet optimal management strategies have not been adequately studied. We hypothesized that implementation of an institutional guideline to standardize and streamline the evaluation and treatment of inpatient cellulitis and abscess would decrease antibiotic and health care resource utilization.

Methods

A retrospective preintervention-postintervention study was performed to compare management before and after implementation of the guideline (January 1, 2007–December 31, 2007, and July 9, 2009–July 8, 2010).

Results

A total of 169 patients (66 with cellulitis, 103 with abscess) were included in the baseline cohort, and 175 (82 with cellulitis, 93 with abscess) were included in the intervention cohort. The intervention led to a significant decrease in use of microbiological cultures (80% vs 66%; P = .003) and fewer requests for inpatient consultations (46% vs 30%; P = .004). The median duration of antibiotic therapy decreased from 13 days (interquartile range [IQR], 10-15 days) to 10 days (IQR, 9-12 days) (P < .001). Fewer patients received antimicrobial agents with broad aerobic gram-negative activity (66% vs 36%; P < .001), antipseudomonal activity (28% vs 18%; P = .02), or broad anaerobic activity (76% vs 49%; P < .001). Clinical failure occurred in 7.7% and 7.4% of cases (P = .93), respectively.

Conclusion

Implementation of a guideline for the management of inpatient cellulitis and cutaneous abscess led to shorter durations of more targeted antibiotic therapy and decreased use of resources without adversely affecting clinical outcomes.

Do Not Abandon Cultures—Reply

Jenkins TC, Burman WJ. — Mon, 27 Jun 2011 00:00:00 GMT

In reply

JAMA Internal Medicine: Skin Infections Topic Collection

The Antibiotic Crisis: Can We Reverse 65 Years of Failed Stewardship? Comment on “Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess” The Antibiotic Crisis

Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess Antibiotics and Cellulitis and Cutaneous Abscess

Do Not Abandon Cultures—Reply