Deviating from IDSA treatment guidelines for non-purulent skin infections increases the risk of treatment failure in emergency department patients
Deviating from IDSA treatment guidelines for non-purulent skin infections increases the risk of treatment failure in emergency department patients
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DOI：
10.1017/s0950268818003291
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发表时间：
2019-01-01
影响因子：
4.2
通讯作者：
Clark, M. A.
中科院分区：
文献类型：
--
作者：
Haran, J. P.;Wilsterman, E.;Clark, M. A.
美国传染病学会（IDSA）定期发布皮肤和软组织感染管理指南;然而，实践模式遵循这些指南的程度以及这是否会影响治疗失败率尚不清楚。我们观察了一个多中心回顾性门诊队列的成人急诊科非化脓性皮肤感染治疗失败率。我们使用多变量逻辑回归来检验IDSA分类的作用以及遵守IDSA指南是否会减少治疗失败。共有759例门诊患者纳入队列，其中17.4%治疗失败。在所有患者中，56.0%接受了与IDSA指南相匹配的治疗，29.1%过度治疗，14.9%治疗不足。在对年龄、性别、感染部位和内科合并症进行调整后，中度感染类型的患者治疗失败的风险增加了3倍（调整后的风险比（aRR）2.98; 95%置信区间（CI）1.15-7.74），重度感染类型的风险增加两倍（aRR 2.27; 95% CI 1.25-4.13）。根据IDSA指南，治疗不足的患者治疗失败的可能性超过2倍（aRR 2.65; 95% CI 1.16-6.05），而过度治疗与治疗失败无关。与年龄≥ 70岁的患者相比，年龄≥ 70岁的患者治疗失败的风险增加56%（aRR 1.56; 95% CI 1.04-2.33），
The Infectious Disease Society of America (IDSA) publishes guidelines regularly for the management of skin and soft tissue infections; however, the extent to which practice patterns follow these guidelines and if this can affect treatment failure rates is unknown. We observed the treatment failure rates from a multicentre retrospective ambulatory cohort of adult emergency department patients treated for a non-purulent skin infection. We used multivariable logistic regression to examine the role of IDSA classification and whether adherence to IDSA guidelines reduced treatment failure. A total of 759 ambulatory patients were included in the cohort with 17.4% failing treatment. Among all patients, 56.0% had received treatments matched to the IDSA guidelines with 29.1% over-treated, and 14.9% under-treated based on the guidelines. After adjustment for age, gender, infection location and medical comorbidities, patients with a moderate infection type had three times increased risk of treatment failure (adjusted risk ratio (aRR) 2.98; 95% confidence interval (CI) 1.15-7.74) and two times increased risk with a severe infection type (aRR 2.27; 95% CI 1.25-4.13) compared with mild infection types. Patients who were under-treated based on IDSA guidelines were over two times more likely to fail treatment (aRR 2.65; 95% CI 1.16-6.05) while over-treatment was not associated with treatment failure. Patients >= 70 years of age had a 56% increased risk of treatment failure (aRR 1.56; 95% CI 1.04-2.33) compared with those