Skin Infections and Antibiotic Stewardship: Analysis of Emergency Department Prescribing Practices, 2007-2010
Skin Infections and Antibiotic Stewardship: Analysis of Emergency Department Prescribing Practices, 2007-2010
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DOI：
10.5811/westjem.2013.8.18040
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发表时间：
2014-05-01
影响因子：
3.1
通讯作者：
Schuur, Jeremiah D.
中科院分区：
文献类型：
--
作者：
Pallin, Daniel J.;Camargo, Carlos A., Jr.;Schuur, Jeremiah D.
简介：国家指南建议大多数皮肤脓肿不需要抗生素，并且蜂窝织炎抗生素应该针对链球菌，而不是社区相关MRSA（CA-MRSA）。本研究的目的是描述抗菌治疗皮肤感染在美国急诊科（ED）和分析潜在的质量measures.Methods：全国医院门诊医疗调查（NHAMCS）是一个4阶段的概率样本的所有非联邦美国艾德访问。2007年，NHAMCS开始记录艾德访视时是否进行切开引流。我们进行了一项回顾性分析，汇总了2007-2010年的数据，使用诊断代码识别皮肤感染，并通过切口和引流的性能识别感染。我们使用加权分析生成国家估计值和95%置信区间;量化频率和比例;并评估抗生素处方实践。我们评估了4个参数，可能作为抗生素管理的质量措施，并提出其中2个潜在的强大足够的implementation.Results：所有艾德访问，3.2%（95%置信区间3.1-3.4%）是皮肤感染，2.7%（2.6-2.9%）是皮肤感染的首次访问，随着时间的推移没有增加（p=0.80）。然而，抗CA-MRSA抗生素的使用从61%（56-66%）增加到74%（71-78%）（p
Introduction: National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA). The objective of this study is to describe antimicrobial treatment of skin infections in U.S. emergency departments (EDs) and analyze potential quality measures.Methods: The National Hospital Ambulatory Medical Care Survey (NHAMCS) is a 4-stage probability sample of all non-federal U.S. ED visits. In 2007 NHAMCS started recording whether incision and drainage was performed at ED visits. We conducted a retrospective analysis, pooling 2007-2010 data, identified skin infections using diagnostic codes, and identified abscesses by performance of incision and drainage. We generated national estimates and 95% confidence intervals using weighted analyses; quantified frequencies and proportions; and evaluated antibiotic prescribing practices. We evaluated 4 parameters that might serve as quality measures of antibiotic stewardship, and present 2 of them as potentially robust enough for implementation.Results: Of all ED visits, 3.2% (95% confidence interval 3.1-3.4%) were for skin infection, and 2.7% (2.6-2.9%) were first visits for skin infection, with no increase over time (p=0.80). However, anti-CA-MRSA antibiotic use increased, from 61% (56-66%) to 74% (71-78%) of antibiotic regimens (p