A multifaceted intervention improves antibiotic stewardship for skin and soft tissues infections

Abstract Objective Assess the effectiveness of a multifaceted stewardship intervention to reduce frequency and duration of inappropriate antibiotic use for emergency department (ED) patients with skin and soft tissue infections (SSTI). We hypothesized the antibiotic stewardship program would reduce antibiotic duration and improve guideline adherence in discharged SSTI patients. Design Nonrandomized controlled trial. Setting Academic EDs (intervention site and control site). Patients or participants Attending physicians and nurse practitioners at participating EDs. Intervention(s) Education regarding guideline-based treatment of SSTI, tests of antimicrobial treatment of SSTI, implementation of a clinical treatment algorithm and order set in the electronic health record, and ED clinicians' audit and feedback. Results We examined 583 SSTIs. At the intervention site, clinician adherence to guidelines improved from 41% to 51% (aOR = 2.13 [95% CI: 1.20–3.79]). At the control site, there were no changes in adherence during the “intervention” period (aOR = 1.17 [0.65–2.12]). The between-site comparison of these during vs. pre-intervention odds ratios was not different (aOR = 1.82 [0.79–4.21]). Antibiotic duration decreased by 26% at the intervention site during the intervention compared to pre-intervention (Adjusted Geometric Mean Ratio [95% CI] = 0.74 [0.66–0.84]). Adherence was inversely associated with SSTI severity (severe vs mild; adjusted OR 0.42 [0.20–0.89]) and purulence (0.32 [0.21–0.47]). Mean antibiotic prescription duration was 1.95 days shorter (95% CI: 1.54–2.33) in the time period following the intervention than pre-intervention period. Conclusions A multifaceted intervention resulted in modest improvement in adherence to guidelines compared to a control site, driven by treatment duration reductions.