Effect of a Multifaceted Stewardship Intervention on Antibiotic Prescribing and Outcomes for Acute Bacterial Skin and Skin Structure Infections

Abstract Background Acute bacterial skin and skin structure infections (ABSSSI) are a leading cause of hospitalization; however, ABSSSI are often treated inappropriately in the inpatient setting. A multifaceted stewardship intervention was implemented at a large health care system to encourage guideline-concordant (GC) antibiotic prescribing. Components included development of a clinical pathway, computerized order set, and provider education. The objective of this study was to examine the impact of this initiative on antimicrobial prescribing practices and patient outcomes. Methods This was a single center, retrospective cohort study of adult inpatients admitted to a medical service over a 9-month period with a primary or secondary diagnosis of ABSSSI. Patients were excluded if they had necrotizing fasciitis, code sepsis, diabetic foot infection, decubitus ulcers, perineal cellulitis, or if immunocompromised. ABSSSI was classified by type (purulent or non-purulent) and severity (mild, moderate, or severe) based on signs of systemic infection. Patients treated during the pre-intervention period (pre-IP) were then compared with patients treated during the post-intervention period (post-IP). The primary endpoint was receipt of GC therapy. Secondary endpoints included receipt of anti-anaerobic (AA) or broad-spectrum agents (BSA), and clinical outcomes such as hospital readmission. Results 125 patients met eligibility criteria, 64 in the pre-IP and 61 in the post-IP. There was a statistically significant increase in prescribing of GC therapy during the post-IP compared with the pre-IP (14% vs. 56%, P < 0.0001). There was also a significant decrease in use of AA therapy (56% vs. 34%, P = 0.01). No difference was observed with the use of BSA, as overall use was low (16% vs. 15%, P = 0.89). The use of the computerized order set during the post-IP was low (18%). There was a numerical, but non-significant reduction in 30-day readmission (14.1% vs. 6.6%, P = 0.17). Conclusion The multifaceted intervention was effective for improving prescribing of GC therapy for ABSSSI. Given low use of the computerized order set, this seemed to be driven by provider education. Strategies around ongoing education may be key to sustain positive results of stewardship interventions. Disclosures All authors: No reported disclosures.