Management of Skin and Soft-Tissue Infections Before and After Clinical Pathway Implementation

Area of Science:

• Infectious Diseases
• Clinical Practice Guidelines
• Pediatric Emergency Medicine

Background:

• Skin and soft-tissue infections (SSTIs) are common emergency department (ED) visits.
• Overuse of methicillin-resistant Staphylococcus aureus (MRSA)-directed therapy and antibiotics for SSTIs is a concern.
• Standardized treatment protocols may optimize antibiotic stewardship.

Purpose of the Study:

• To evaluate the impact of a clinical pathway on MRSA-directed therapy for cellulitis and antibiotic use for abscesses.
• To assess the safety and efficiency of the clinical pathway using revisit rates and ED length of stay (LOS).

Main Methods:

• Retrospective cohort study comparing pre-pathway and post-pathway periods.
• Inclusion criteria: patients aged 57 days to 18 years with cellulitis or abscess discharged from the ED.
• Data collected on MRSA-directed therapy, systemic antibiotic use, 72-hour revisit rates, and ED LOS.

Main Results:

• The proportion of simple cellulitis patients receiving MRSA-directed therapy decreased from 81% to 54%.
• Systemic antibiotic use for drained abscesses decreased from 88% to 75%.
• No significant increase in 72-hour revisit rates (3.8% vs 3.2%) or ED LOS (2.8 vs 2.7 hours) was observed.

Conclusions:

• Implementation of a clinical pathway for SSTIs effectively reduced unnecessary MRSA-directed therapy and antibiotic prescribing.
• The clinical pathway is a safe and effective strategy for managing pediatric SSTIs without compromising patient safety or ED efficiency.