Jenkins Timothy C, Knepper Bryan C, Sabel Allison L, Sarcone Ellen E, Long Jeremy A, Haukoos Jason S, Morgan Steven J, Biffl Walter L, Steele Andrew W, Price Connie S, Mehler Philip S, Burman William J
Department of Medicine, Denver Health Medical Center, Denver, CO 80204, USA.
Arch Intern Med. 2011 Jun 27;171(12):1072-9. doi: 10.1001/archinternmed.2011.29. Epub 2011 Feb 28.
Cellulitis and cutaneous abscess are among the most common infections leading to hospitalization, yet optimal management strategies have not been adequately studied. We hypothesized that implementation of an institutional guideline to standardize and streamline the evaluation and treatment of inpatient cellulitis and abscess would decrease antibiotic and health care resource utilization.
A retrospective preintervention-postintervention study was performed to compare management before and after implementation of the guideline (January 1, 2007-December 31, 2007, and July 9, 2009-July 8, 2010).
A total of 169 patients (66 with cellulitis, 103 with abscess) were included in the baseline cohort, and 175 (82 with cellulitis, 93 with abscess) were included in the intervention cohort. The intervention led to a significant decrease in use of microbiological cultures (80% vs 66%; P = .003) and fewer requests for inpatient consultations (46% vs 30%; P = .004). The median duration of antibiotic therapy decreased from 13 days (interquartile range [IQR], 10-15 days) to 10 days (IQR, 9-12 days) (P < .001). Fewer patients received antimicrobial agents with broad aerobic gram-negative activity (66% vs 36%; P < .001), antipseudomonal activity (28% vs 18%; P = .02), or broad anaerobic activity (76% vs 49%; P < .001). Clinical failure occurred in 7.7% and 7.4% of cases (P = .93), respectively.
Implementation of a guideline for the management of inpatient cellulitis and cutaneous abscess led to shorter durations of more targeted antibiotic therapy and decreased use of resources without adversely affecting clinical outcomes.
蜂窝织炎和皮肤脓肿是导致住院的最常见感染之一，但最佳管理策略尚未得到充分研究。我们假设实施一项机构指南以规范和简化住院蜂窝织炎和脓肿的评估与治疗，将减少抗生素和医疗资源的使用。
进行了一项回顾性干预前-干预后研究，以比较指南实施前后（2007年1月1日至2007年12月31日，以及2009年7月9日至2010年7月8日）的管理情况。
基线队列共纳入169例患者（66例蜂窝织炎，103例脓肿），干预队列纳入175例（82例蜂窝织炎，93例脓肿）。干预导致微生物培养的使用显著减少（80%对66%；P = 0.003），住院会诊请求减少（46%对30%；P = 0.004）。抗生素治疗的中位持续时间从13天（四分位间距[IQR]，10 - 15天）降至10天（IQR，9 - 12天）（P < 0.001）。接受具有广泛需氧革兰氏阴性菌活性（66%对36%；P < 0.001）、抗假单胞菌活性（28%对18%；P = 0.02）或广泛厌氧活性（76%对49%；P < 0.001）抗菌药物的患者减少。临床失败分别发生在7.7%和7.4%的病例中（P = 0.93）。
实施住院蜂窝织炎和皮肤脓肿管理指南导致更具针对性的抗生素治疗持续时间缩短，资源使用减少，且未对临床结果产生不利影响。
