Past Decade Shows Increasing Use of Broad-Spectrum Antibiotics for Inpatient cSSSI, Research Indicates

   Initial inpatient antibiotic therapy for complicated skin and skin structure infection (cSSSI) has changed substantially over the past decade, according to data presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy in Boston.  Specifically, the use of vancomycin and piperacillin/tazobaxctam expanded significantly, likely in response to increasing concerns about antimicrobial resistance and changes in cSSSI treatment guidelines.

   Co-investigator David J. Weber, MD, MPH, of the University of North Carolina School of Medicine in Chapel Hill, presented the findings.

   Using a large, multiple hospital database, the researchers identified all patients hospitalized (N=22,382) for cSSSI (eg, abscess, cellulitis, pilonidal cyst with abscess, decubitus ulcer, and surgical-site infection) between 2000 and 2009 involving receipt of parenteral antibiotic therapy for >/=48 hours (except in event of death), beginning </= 24 hours following  admission. The mean age of the patients was 55.9, and 47.8% were women. Initial antibiotic therapy was defined as all parenteral antibiotics received within the first 24 hours. Dr. Weber and colleagues examined changes in initial regimen over the study period.

   Following data analysis, the use of vancomycin, either as a single agent or as part of a multidrug regimen, increased from 16.5% of all such admissions in 2000-2001 to 55.4% in 2008-2009. The use of piperacillin/tazobactam increased from 6.8% to 20.9% (both P<.001). However, the use of ampicillin/sulbactam declined from 23.7% to 12.1%, and use of cefazolin declined from 33.4% to 13.1% (both P<.001). The use of multi-drug regimens increased over the period from 35.1% to 43.7% (P<.001).

   “Our findings suggest that physicians are increasingly concerned about the causal role of hard-to-treat pathogens in cSSSI,” Dr. Weber said. “The trends we noted -- namely, increased use of agents with relatively broad coverage, and declining use of those with relatively narrow coverage -- were quite marked.”