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Predictors of Oral Antibiotic Treatment Failure for Nonpurulent Skin and Soft Tissue Infections in the Emergency Department
Author(s) -
Yadav Krishan,
Suh Kathryn N.,
Eagles Debra,
MacIsaac John,
Ritchie Darmyn,
Bernick Jordan,
Thiruganasambandamoorthy Venkatesh,
Wells George,
Stiell Ian G.
Publication year - 2019
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13492
Subject(s) - medicine , cellulitis , emergency department , antibiotics , odds ratio , confidence interval , intensive care medicine , surgery , psychiatry , microbiology and biotechnology , biology
Background Current guideline recommendations for optimal management of nonpurulent skin and soft tissue infections ( SSTI s) are based on expert consensus. There is a lack of evidence to guide emergency physicians regarding selection of patients for oral versus intravenous antibiotic therapy. The primary objective was to identify predictors associated with oral antibiotic treatment failure. Methods We performed a health records review of adults (age ≥ 18 years) with nonpurulent SSTI s treated at two tertiary care emergency departments ( ED s). Oral antibiotic treatment failure was defined as any of the following after a minimum of 48 hours of oral therapy due to worsening infection: 1) hospitalization, 2) change in class of oral antibiotic, or 3) switch to intravenous therapy. Multivariable logistic regression was used to identify predictors independently associated with oral antibiotic treatment failure. Results We identified 500 patients (mean ± SD age = 64 ± 19 years, 279 male [55.8%], and 126 [25.2%] with diabetes). Of 288 patients who had received a minimum of 48 hours of oral antibiotics, there were 85 oral antibiotic treatment failures (29.5%). Tachypnea at triage (odds ratio [ OR ] = 6.31, 95% confidence interval [ CI ] = 1.80 to 22.08), chronic ulcers ( OR = 4.90, 95% CI = 1.68–14.27), history of methicillin‐resistant Staphylococcus aureus ( MRSA ) colonization or infection ( OR = 4.83, 95% CI = 1.51 to 15.44), and cellulitis in the past 12 months ( OR = 2.23, 95% CI = 1.01 to 4.96) were independently associated with oral antibiotic treatment failure Conclusion This is the first study to evaluate predictors of oral antibiotic treatment failure for nonpurulent SSTI s treated in the ED . Tachypnea at triage, chronic ulcers, history of MRSA colonization or infection, and cellulitis within the past year were independently associated with oral antibiotic treatment failure. Emergency physicians should consider these risk factors when deciding on oral versus intravenous antimicrobial therapy for outpatient management of nonpurulent SSTI s.