Predictors of Failure for Oral Antibiotics Treating Nonpurulent Skin and Soft Tissue Infections
The Article: Yadav, Krishan, et al. “Predictors of Oral Antibiotic Treatment Failure for Nonpurulent Skin and Soft Tissue Infections in the Emergency Department.” Academic Emergency Medicine (2019).
The Idea: Look for risk factors to better predict oral antibiotic treatment failure. Following 48-hours of treatment with oral antibiotic what predictors suggest the need for hospitalization, changing class of oral antibiotics, or switching to intravenous antibiotic.
The Study: Adult emergency department patients with nonpurulent skin and soft tissue infections (SSTIs) were followed after being initiated on outpatient oral antibiotic therapy. 288 patients received a minimum of 48 hours of oral antibiotics with a failure rate of 29.5%.
The Findings: Tachypnea at initial triage (odds ratio (OR) = 6.31), chronic ulcers (OR = 4.90), history of methicillin-resistant Staphylococcus Aureus (MRSA) colonization or prior infection (OR = 4.83), and cellulitis in the past 12 months (OR = 2.23) were all independently associated with failure of treatment by oral antibiotics.
The Takeaway: For non-purulent SSTIs tachypnea, chronic ulcers, history of MRSA, and recent cellulitis predict failure of oral antibiotic therapy. Consider these factors when deciding optimal route of antibiotic therapy for cellulitis and erysipelas.