SALT LAKE CITY — Guidelines aren’t followed enough when skin and soft tissue infections are managed in the outpatient setting outside of emergency departments, a new study pointed out.

The article in Clinical Infectious Diseases noted the lack of data on treatment patterns outside the ED and suggested there might be poor adherence to SSTI treatment guidelines.1

To help clarify the situation, VA Salt Lake City Health Care System-led researchers conducted a retrospective cohort study of veterans diagnosed with SSTIs in the ED or outpatient clinics from Jan. 1, 2005, to June 30, 2018. Researchers documented the incidence of SSTIs over time, as well as antibiotic selection and incision and drainage. The study also compared anti-methicillin-resistant Staphylococcus aureus antibiotic use to SSTI treatment guidelines.

Overall, about 1.7 million incident SSTIs were identified in 1.15 million patients during the study period.

The authors reported that the incidence of SSTIs significantly decreased from 4.58 in 2005 to 3.27 per 1,000 patient-years in 2018 (p<0.001). They also described how lower rates of β-lactam prescribing (32.5% vs. 51.7%) occurred in the ED compared to primary care (PC), while the ED had higher rates of anti-MRSA therapy (51.4% vs. 35.1%) compared to primary care.

In addition, the I&D rate in the ED was 8.1% compared to 2.6% in PC. The authors also noted that antibiotic regimens without MRSA activity were prescribed in 24.9% of purulent SSTIs. Anti-MRSA antibiotics were prescribed in 40.1% of nonpurulent SSTIs.

“We found a decrease in the incidence of SSTIs in the outpatient setting over time,” according to the study. “Treatment of SSTIs varied depending on the presenting ambulatory location. There is poor adherence to guidelines in regard to use of anti-MRSA therapies. Further study is needed to understand the impact of guideline non-adherence on patient outcomes.”

  1. Rhoads JLW, Willson TM, Sutton JD, Spivak ES, Samore MH, Stevens VW. Epidemiology, disposition and treatment of ambulatory Veterans with skin and soft tissue infections [published online ahead of print, 2020 Feb 12]. Clin Infect Dis. 2020;ciaa133. doi:10.1093/cid/ciaa133