Miller Mackenzie L, Hughson Destiny M, Blower Noah D, Jameson Andrew P, Dumkow Lisa E
Department of Pharmacy, Trinity Health Grand Rapids, Grand Rapids, MI, USA.
Division of Infectious Diseases, Trinity Health Grand Rapids, Grand Rapids, MI, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Feb 6;5(1):e31. doi: 10.1017/ash.2024.441. eCollection 2025.
Evaluate prescribing practices and risk factors for treatment failure in obese patients treated for purulent cellulitis with oral antibiotics in the outpatient setting.
Retrospective, multicenter, observational cohort.
Emergency departments, primary care, and urgent care sites throughout Michigan.
Adult patients with a body mass index of ≥ 30 kg/m who received ≥ 5 days of oral antibiotics for purulent cellulitis were included. Key exclusion criteria were chronic infections, antibiotic treatment within the past 30 days, and suspected polymicrobial infections.
Obese patients receiving oral antibiotics for purulent cellulitis between February 1, 2020, and August 31, 2023, were assessed. The primary objective was to describe outpatient prescribing trends. Secondary objectives included comparing patient risk factors for treatment failure and safety outcomes between patients experiencing treatment success and those experiencing treatment failure.
Two hundred patients were included (Treatment success, n = 100; Treatment failure, n = 100). Patients received 11 antibiotic regimens with 26 dosing variations; 45.5% were inappropriately dosed. Sixty-seven percent of patients received MRSA-active therapy. Treatment failure was similar between those appropriately dosed (46.4%) versus under-dosed (54.4%) ( = 0.256), those receiving 5-7 days of therapy (47.1%) versus 10-14 days (54.4%) ( = 0.311), and those receiving MRSA-active therapy (52.2%) versus no MRSA therapy (45.5%) ( = 0.367). Patients treated with clindamycin were more likely to experience treatment failure (73.7% vs 47.5%, = 0.030).
Nearly half of antimicrobial regimens prescribed for outpatient treatment of cellulitis in patients with obesity were suboptimally prescribed. Opportunities exist to optimize agent selection, dosing, and duration of therapy in this population.
评估门诊环境下接受口服抗生素治疗化脓性蜂窝织炎的肥胖患者的处方实践及治疗失败的风险因素。
回顾性、多中心、观察性队列研究。
密歇根州各地的急诊科、初级保健机构和紧急护理点。
体重指数≥30kg/m²且因化脓性蜂窝织炎接受≥5天口服抗生素治疗的成年患者。主要排除标准为慢性感染、过去30天内接受过抗生素治疗以及疑似混合微生物感染。
对2020年2月1日至2023年8月31日期间接受口服抗生素治疗化脓性蜂窝织炎的肥胖患者进行评估。主要目的是描述门诊处方趋势。次要目的包括比较治疗成功和治疗失败患者的治疗失败风险因素及安全结局。
纳入200例患者（治疗成功，n = 100；治疗失败，n = 100）。患者接受了11种抗生素方案，有26种给药方式；45.5%的给药剂量不合适。67%的患者接受了针对耐甲氧西林金黄色葡萄球菌（MRSA）的活性治疗。给药剂量合适的患者（46.4%）与给药不足的患者（54.4%）（P = 0.256）、接受5 - 7天治疗的患者（47.1%）与接受10 - 14天治疗的患者（54.4%）（P = 0.311）以及接受针对MRSA活性治疗的患者（52.2%）与未接受针对MRSA治疗的患者（45.5%）（P = 0.367）之间的治疗失败情况相似。接受克林霉素治疗的患者更有可能出现治疗失败（73.7%对47.5%，P = 0.030）。
肥胖患者门诊治疗蜂窝织炎所开抗菌药物方案中近一半的处方并不理想。在这一人群中存在优化药物选择、给药剂量和治疗疗程的机会。
