Background
Methods
Study design and sample selection
Measures
Statistical analyses
Results
Province | Total patient charts reviewed | Total number of patient-charts that contained at least one prescription of antibiotic(s) | Number of patient-charts that contained at least one SSTI casea | Total number of cases recorded from patient-charts | Number of SSTI cases recorded from patient-charts | Total number of antibiotic prescriptions | Prevalence of antibiotic use |
---|---|---|---|---|---|---|---|
Alberta | 60 | 39 | 7 | 77 | 8 | 89 | 0.650 |
Saskatchewan | 70 | 40 | 16 | 63 | 21 | 81 | 0.571 |
Manitoba | 120 | 64 | 29 | 170 | 60 | 207 | 0.533 |
Ontario | 100 | 68 | 24 | 126 | 34 | 162 | 0.680 |
Quebec | 22 | 13 | 10 | 23 | 14 | 25 | 0.591 |
Total | 372 | 224 | 86 | 459 | 137 | 569 | 0.602 |
Variable | All patients with at least one antibiotic prescription | Patients with at least one antibiotic prescription for SSTI | p-value | ||
---|---|---|---|---|---|
Total N = 224 | Total N = 86 | ||||
n | (%) | n | (%) | ||
Gender | 0.0939 | ||||
Male | 91 | (40.63) | 44 | (51.16) | |
Female | 133 | (59.38) | 42 | (48.84) | |
Age | 0.6956 | ||||
18–30 | 95 | (42.41) | 39 | (45.35) | |
31–40 | 51 | (22.77) | 15 | (17.44) | |
41–50 | 40 | (17.86) | 18 | (20.93) | |
51–60 | 20 | (8.93) | 10 | (11.63) | |
61–70 | 12 | (5.36) | 2 | (2.33) | |
70+ | 6 | (2.68) | 2 | (2.33) | |
Creatinine Clearnance | 0.8741 | ||||
< 60 mL/min | 10 | (4.46) | 5 | (5.81) | |
> 60 mL/min | 197 | (87.95) | 75 | (87.21) | |
Missing | 17 | (7.59) | 6 | (6.98) | |
Pre-existing conditions | |||||
Diabetes | 48 | (21.43) | 18 | (20.93) | 0.9235 |
Cardiac disease | 42 | (18.75) | 19 | (22.09) | 0.5074 |
Alcohol use disorder | 40 | (17.86) | 20 | (23.26) | 0.2814 |
Renal disease | 13 | (5.80) | 7 | (8.14) | 0.4535 |
Pregnancy | 12 | (5.36) | 0 | (0.00) | 0.0416 |
Liver disease | 10 | (4.46) | 4 | (4.65) | 1.000 |
COPD | 6 | (2.68) | 2 | (2.33) | 1.000 |
Immuno-compromised | 3 | (1.34) | 2 | (2.33) | 0.6198 |
Asplenia | 0 | (0.00) | 0 | (0.00) | – |
Other disease | 103 | (45.98) | 38 | (44.19) | 0.7762 |
Presence of medical device | |||||
Urinary catheter | 1 | (0.45) | 1 | (1.16) | 0.4785 |
Central line | 0 | (0.00) | 0 | (0.00) | – |
Other device | 5 | (2.23) | 2 | (2.33) | 1.0000 |
Variables | n | % |
---|---|---|
Etiologic agent | ||
MRSAa | 55 | (40.15) |
MSSA | 5 | (3.65) |
Other organism | 8 | (5.84) |
Unknown organism | 69 | (50.36) |
Primary SSTI symptom | ||
Purulentb | 34 | (24.82) |
Non-purulentc | 15 | (10.95) |
Skin breakdownd | 17 | (12.41) |
Woundse | 34 | (24.82) |
Unknown | 37 | (27.01) |
Wound care | ||
Yes | 67 | (48.91) |
No | 70 | (51.09) |
Incision & drainage | ||
Yes | 12 | (8.76) |
Purulent | 8 | (5.84) |
Non-purulent | 1 | (0.73) |
Skin breakdown | 0 | (0.00) |
Wounds | 0 | (0.00) |
Unknown | 3 | (2.19) |
No | 125 | (91.24) |
Type of antibiotic | ||
Topical only | 24 | (17.52) |
Topical and oral | 12 | (8.76) |
Oral only | 86 | (62.77) |
IV | 12 | (8.76) |
Missing | 2 | (1.46) |
Combination therapy | ||
Yes | 41 | (29.93) |
No | 96 | (70.07) |
Adjunctive therapy | ||
Yes | 68 | (49.64) |
No | 69 | (50.36) |
Clinical Outcomes | ||
Cure | 16 | (11.68) |
Failure | 19 | (13.87) |
Improvement | 17 | (12.41) |
Unknown | 84 | (61.31) |
Diagnostic test | n | (%) |
---|---|---|
Blood culture | 2 | (1.46) |
Complete Blood Count (CBC) | 4 | (2.92) |
Wound culture (n = 40)a | 40 | (29.20) |
Purulent | 9 | (22.50) |
Non-purulent | 3 | (7.50) |
Skin breakdown | 1 | (2.50) |
Wounds | 9 | (22.50) |
Unknown | 18 | (45.00) |
No diagnostic test | 84 | (61.31) |
Missing | 7 | (5.11) |
Antibiotic susceptibility | Erythromycin | Clindamycin | Tetracycline | Co-trimoxazole | Vancomycin | Oxacillin | Gentamicin | Linezolid | Cefazolin | Penicillin |
---|---|---|---|---|---|---|---|---|---|---|
Number of MRSA isolates (%) | 6 (28.6) | 19 (90.5) | 21 (100) | 20 (95.2) | 21 (100) | 0 | 21 (100) | 21 (100) | 0 | 0 |
Overall appropriateness | Inappropriate but not resulting in ineffective therapy, n (%) | Appropriate, n (%) | Inappropriate resulting in ineffective therapy, n (%) | Unable to assess, n (%) |
---|---|---|---|---|
SSTIs (n = 134a) | 20 (14.93) | 82 (61.19) | 20 (14.93) | 12 (8.96) |
MRSA (n = 55) | 11 (20.0) | 28 (50.91) | 14 (25.45) | 2 (3.64) |
MSSA (n = 5) | 0 (0) | 1 (20.0) | 1 (20.0) | 3 (60.0) |
By prescriber type (n = 131a) | ||||
RN | 11 (11.96) | 58 (63.04) | 16 (17.39) | 6 (6.52) |
NP | 0 (0) | 8 (80.00) | 0 (0) | 2 (10.00) |
MD | 9 (29.03) | 16 (51.61) | 4 (12.90) | 1 (3.23) |