Frequent Emergency Medicine Decision-Making Factors in ABSSSI Treatment

This article is part of Infectious Disease Advisor’s in-depth coverage of IDWeek 2017™, which took place in San Diego, CA. Our staff will be reporting on the latest treatment advancements and research initiatives for skin infections. Check back regularly for highlights from IDWeek 2017.

Choosing between intravenous (IV) vs oral antibiotic therapy as well as whether to admit or discharge a patient are 2 common treatment-related decisions emergency medicine (EM) providers must make when treating patients with an acute bacterial skin and skin structure infection (ABSSSI), according to results of a survey-based study presented at IDWeek 2017, held October 4-8 in San Diego, California.

“ABSSSIs are a frequent cause of emergency room visits,” note the investigators, and “there are limited data on factors that influence the provider’s decision for the treatment of ABSSSI.”

EM providers (N=130) were asked to complete an anonymous survey to assess practitioners’ decision-making choices about clinical cases of ABSSSI. Each participant was asked to provide his or her decisions for each case with regard to type of antibiotic therapy (IV, oral, or both) and to describe the components that played a role in each decision.

For one patient with ABSSSI that did not relapse, and who did not have systemic inflammatory response syndrome (SIRS) or diabetes, the majority of EM providers chose oral antibiotic therapy and hospital discharge (93.1% and 96.2%, respectively). The second case, which involved a patient with ABSSSI and relapse, resulted in providers opting for fewer oral antibiotics and discharge (48.5% and 51.5%, respectively).

In the third case involving a person with ABSSSI and controlled diabetes, 53.5% of providers suggested oral antibiotics and 62.8% suggested discharge. Case 4, which involved a person with ABSSSI and SIRS, caused the majority of providers to choose IV antibiotics (95.3%) and hospital admission (96.1%).

Only 3.8% of survey respondents suggested providing a patient with relapse or diabetes with 1 to 2 IV antibiotic doses followed by oral antibiotic therapy. Overall, physicians chose oral antibiotics more frequently than advanced practice providers for the patients with diabetes and SIRS.

“Variability in responses to patient cases suggests opportunities for education and the development of an ABSSSI clinical pathway to guide treatment,” concluded the investigators.

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Reference

Abuhussain SA, Krawczynski M, Tart S, et al. Variability in emergency medicine (EM) provider decisions on hospital admission and antibiotic (ABX) treatment for acute bacterial skin and skin structure infections (ABSSSI). Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Poster 696.