Antibiotic Management of Uncomplicated Skin and Soft Tissue Infections in the Real World
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patients
2.2. Variables
- Sociodemographic:
- b.
- Clinics:
- c.
- Pharmacological/management:
- d.
- Other management:
- e.
- Follow-up:
2.3. Ethical Statement
2.4. Data Analysis
3. Results
3.1. Sociodemographic
3.2. Clinicians
3.3. Treatment
3.4. Multivariate Analysis
3.5. Follow-Up
4. Discussion
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Purulent Infections | Nonpurulent Infections | p | ||
---|---|---|---|---|---|
n = 200 | % | n = 200 | % | ||
Men | 98 | 49.0 | 111 | 55.5 | 0.193 |
Age, median (IQR) | 36.0 (28.0–47.0) | 40.0 (30.0–53.0) | 0.023 a | ||
Origin | - | - | - | - | |
Bogotá-Cundinamarca Region | 46 | 23.0 | 83 | 41.5 | <0.001 |
Caribbean Region | 73 | 36.5 | 56 | 28.0 | 0.069 |
Central Region | 62 | 31.0 | 42 | 21.0 | 0.023 |
Pacific Region | 17 | 8.5 | 8 | 4.0 | 0.063 |
Eastern Region/Orinoquia-Amazonia | 2 | 1.0 | 11 | 5.5 | 0.020 b |
Scholarship | - | - | - | - | |
Primary | 10 | 5.0 | 13 | 6.5 | 0.519 |
Secondary | 74 | 37.0 | 50 | 25.0 | 0.009 |
University | 32 | 16.0 | 15 | 7.5 | 0.008 |
Occupation | - | - | - | - | |
Household activities | 36 | 18.0 | 37 | 18.5 | 0.897 |
Student | 19 | 9.5 | 12 | 6.0 | 0.191 |
Worker | 13 | 6.5 | 16 | 8.0 | 0.563 |
Affiliation regime | - | - | - | - | |
Contributory | 183 | 91.5 | 183 | 91.5 | 1.000 |
Subsidized | 17 | 8.5 | 17 | 8.5 |
Variables | Purulent Infections | Nonpurulent Infections | p | ||
---|---|---|---|---|---|
n = 200 | % | n = 200 | % | ||
Signs/Symptoms | - | - | - | - | |
Pain | 180 | 90.0 | 192 | 96.0 | 0.019 |
Erythema or flushing | 143 | 71.5 | 181 | 90.5 | <0.001 |
Induration | 122 | 61.0 | 0 | 0.0 | <0.001 |
Fever | 17 | 8.5 | 23 | 11.5 | 0.317 |
General discomfort | 10 | 5.0 | 25 | 12.5 | 0.008 |
Risk factors | - | - | - | - | |
Previous use of antibiotics | 26 | 13.0 | 21 | 10.5 | 0.438 |
Penetrating trauma | 2 | 1.0 | 5 | 2.5 | 0.449 a |
Recent hospitalization | 0 | 0.0 | 2 | 1.0 | 0.499 a |
Renal replacement therapy | 0 | 0.0 | 1 | 0.5 | 1.000 a |
Vital signs | - | - | - | - | |
Systolic blood pressure (mmHg), median (IQR) | 110.0 (110.0–116.0) | 110.0 (110.0–120.0) | 0.012 b | ||
Diastolic blood pressure (mmHg), median (IQR) | 70.0 (70.0–75.0) | 70.0 (70.0–77.8) | 0.016 b | ||
Heart rate (beats/minute), median (IQR) | 78.0 (75.0–84.0) | 78.0 (75.0–83.0) | 0.481 b | ||
Respiratory rate (breaths/minute), median (IQR) | 18.0 (16.0–19.0) | 18.0 (17.0–19.0) | 0.231 b | ||
Temperature (°C), median (RIQ) | 36.2 (36.0–36.5) | 36.0 (36.0–36.5) | 0.524 b | ||
Anthropometric measures | - | - | - | - | |
Weight (kg), median (IQR) | 70.0 (60.0–79.0) | 70.0 (60.0–80.0) | 0.757 b | ||
Body mass index (kg/m2), median (IQR) | 25.4 (22.5–28.7) | 25.7 (23.7–28.3) | 0.384 b | ||
Location of infection | - | - | - | - | |
Thigh or leg | 40 | 20.0 | 59 | 29.5 | 0.028 |
Thorax or back | 35 | 17.5 | 20 | 10.0 | 0.029 |
Head or face | 16 | 8.0 | 25 | 12.5 | 0.138 |
Gluteus | 26 | 13.0 | 9 | 4.5 | 0.003 |
Forearm or arm | 14 | 7.0 | 15 | 7.5 | 0.847 |
Comorbidities | - | - | - | - | |
Arterial hypertension | 38 | 19.0 | 41 | 20.5 | 0.706 |
Obesity | 35 | 17.5 | 35 | 17.5 | 1.000 |
Dyslipidemia | 25 | 12.5 | 28 | 14.0 | 0.658 |
Diabetes mellitus | 21 | 10.5 | 19 | 9.5 | 0.739 |
Migraine | 13 | 6.5 | 19 | 9.5 | 0.269 |
Variables | Purulent Infections | Nonpurulent Infections | p | ||
---|---|---|---|---|---|
n = 200 | % | n = 200 | % | ||
Place of care | - | - | - | - | |
External consultation | 169 | 84.5 | 143 | 71.5 | 0.002 |
Emergencies | 31 | 15.5 | 52 | 26.0 | 0.010 |
Home consultation | 0 | 0.0 | 5 | 2.5 | 0.061 a |
Antibiotics | - | - | - | - | |
Cephalexin | 81 | 40.5 | 75 | 37.5 | 0.539 |
Dicloxacillin | 56 | 28.0 | 56 | 28.0 | 1.000 |
Clindamycin | 29 | 14.5 | 43 | 21.5 | 0.068 |
Gentamicin | 14 | 7.0 | 8 | 4.0 | 0.188 |
Trimethoprim/sulfamethoxazole | 8 | 4.0 | 8 | 4.0 | 1.000 |
Analgesics | - | - | - | - | |
Naproxen | 96 | 48.0 | 105 | 52.5 | 0.368 |
Acetaminophen | 25 | 12.5 | 40 | 20.0 | 0.042 |
Diclofenac | 28 | 14.0 | 32 | 16.0 | 0.575 |
Ibuprofen | 19 | 9.5 | 15 | 7.5 | 0.473 |
Tramadol | 9 | 4.5 | 5 | 2.5 | 0.276 |
Comedications | - | - | - | - | |
Analgesics/antiinflammatories | 55 | 27.5 | 68 | 34.0 | 0.159 |
Antihypertensives and diuretics | 24 | 12.0 | 26 | 13.0 | 0.762 |
Lipid-lowering drugs | 18 | 9.0 | 24 | 12.0 | 0.328 |
Antiulcer medication | 18 | 9.0 | 15 | 7.5 | 0.586 |
Antidiabetics | 13 | 6.5 | 13 | 6.5 | 1.000 |
Antibiotic | n = 400 | % | Prescribed Dose (mg/day) | Days | Sex | Age | Appropriate Use | ||||
---|---|---|---|---|---|---|---|---|---|---|---|
Median (IQR) | Mode | nDDD a | Median (IQR) | M (%) | F (%) | Median (IQR) | Yes (%) | No (%) | |||
Cephalexin | 156 | 39.0 | 2000 (1500–2000) | 2000 | 0.9 | 7 (7–7) | 51.3 | 48.7 | 37.0 (29.3–49.8) | 45.5 | 54.5 |
Dicloxacillin | 112 | 28.0 | 2000 (1750–2000) | 2000 | 0.9 | 7 (7–7) | 59.8 | 40.2 | 38.5 (27.0–48.0) | 42.0 | 58.0 |
Clindamycin | 72 | 18.0 | 1200 (900–1800) | 1800 | 1.2 | 7 (4–7) | 48.6 | 51.4 | 40.5 (30.0–52.8) | 100.0 | 0.0 |
Gentamicin | 22 | 5.5 | 160 (157.5–160) | 160 | 0.6 | 3 (3–4.3) | 63.6 | 36.4 | 41.0 (34.0–47.8) | 0.0 | 100.0 |
Trimethoprim/sulfamethoxazole | 16 | 4.0 | 400 (320–480) | 480 | 1.0 | 7 (7–10) | 43.8 | 56.3 | 41.0 (31.0–47.0) | 100.0 | 0.0 |
Doxycycline | 14 | 3.5 | 200 (200–225) | 200 | 2.1 | 7 (7–15) | 14.3 | 85.7 | 34.5 (24.8–44.0) | 0.0 | 100.0 |
Cephradine | 8 | 2.0 | 1500 (1000–2000) | 1000 | - | 7 (7–7) | 50.0 | 50.0 | 53.5 (36.5–68.8) | 12.5 | 87.5 |
Ciprofloxacin | 7 | 1.8 | 800 (800–800) | 800 | 1.0 | 7 (7–10) | 57.1 | 42.9 | 48.0 (35.0–63.0) | 0.0 | 100.0 |
Amoxicillin | 5 | 1.3 | 1500 (1500–1750) | 1500 | 1.1 | 7 (7–7) | 80.0 | 20.0 | 49.0 (26.5–54.5) | 0.0 | 100.0 |
Amoxicillin/clavulanate | 4 | 1.0 | 2000 (1906.3–2750.0) | 2000 | 1.5 | 7 (7–7) | 50.0 | 50.0 | 37.0 (29.8–43.5) | 50.0 | 50.0 |
Metronidazole | 4 | 1.0 | 1500 (1125.0–1500) | 1500 | 0.9 | 7 (2.5–7) | 50.0 | 50.0 | 36.0 (26.5–47.8) | 0.0 | 100.0 |
Oxacillin | 4 | 1.0 | 2000 (2000–6500) | 2000 | 1.8 | 3 (1.5–3.8) | 25.0 | 75.0 | 40.0 (23.3–42.5) | 75.0 | 25.0 |
Cefazolin | 3 | 0.8 | 2000 (1500–3000) | 1500 | 0.7 | 7 (7–8) | 33.3 | 66.7 | 40.0 (27.0–57.0) | 100.0 | 0.0 |
Ceftriaxone | 3 | 0.8 | 2000 (1000–2000) | 2000 | 0.8 | 3 (1–4) | 0.0 | 100.0 | 68.0 (26.0–72.0) | 0.0 | 100.0 |
Benzathine benzylpenicillin | 3 | 0.8 | 24,00,000 (1,200,000–2,400,000) | 2,400,000 | - | 1 (1–1) | 66.7 | 33.3 | 30.0 (28.0–58.0) | 0.0 | 100.0 |
Amikacin | 2 | 0.5 | 500 (500–500) | 500 | 0.5 | 4.5 (4–5) | 0.0 | 100.0 | 35.5 (25.0–46.0) | 0.0 | 100.0 |
Cephalothin | 2 | 0.5 | 2000 (1000–3000) | 1000 | 0.5 | 4 (1–7) | 50.0 | 50.0 | 58.0 (39.0–77.0) | 0.0 | 100.0 |
Cefepime | 1 | 0.3 | 4000 | 4000 | 1.0 | 7 | 100.0 | 0.0 | 82.0 | 0.0 | 100.0 |
Clarithromycin | 1 | 0.3 | 1000 | 1000 | 2.0 | 3 | 0.0 | 100.0 | 37.0 | 0.0 | 100.0 |
Norfloxacin | 1 | 0.3 | 800 | 800 | 1.0 | 7 | 100.0 | 0.0 | 21.0 | 0.0 | 100.0 |
Vancomycin | 1 | 0.3 | 2000 | 2000 | 1.0 | 9 | 100.0 | 0.0 | 26.0 | 100.0 | 0.0 |
Variables | Sig. | OR | 95%CI | |
---|---|---|---|---|
Lower | Upper | |||
Men | 0.285 | 1.353 | 0.777 | 2.354 |
Age < 40 years | 0.747 | 1.100 | 0.616 | 1.966 |
Caribbean region | 0.654 | 0.874 | 0.486 | 1.574 |
Scholarship university | 0.570 | 1.278 | 0.548 | 2.980 |
Contributory regime | 0.276 | 1.721 | 0.648 | 4.567 |
Arterial hypertension | 0.922 | 1.037 | 0.504 | 2.131 |
Obesity | 0.764 | 0.894 | 0.431 | 1.854 |
Outpatient care | 0.033 | 2.093 | 1.063 | 4.123 |
Presence of pain | 0.008 | 3.721 | 1.415 | 9.785 |
Thigh/leg location | 0.573 | 1.196 | 0.642 | 2.227 |
Purulent infection | <0.001 | 25.716 | 14.527 | 45.522 |
Receipt of medication in the last 3 months | 0.538 | 1.199 | 0.673 | 2.136 |
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Valladales-Restrepo, L.F.; Aristizábal-Carmona, B.S.; Giraldo-Correa, J.A.; Acevedo-Medina, L.F.; Valencia-Sánchez, L.; Acevedo-López, D.T.; Gaviria-Mendoza, A.; Machado-Duque, M.E.; Machado-Alba, J.E. Antibiotic Management of Uncomplicated Skin and Soft Tissue Infections in the Real World. Microorganisms 2023, 11, 1369. https://doi.org/10.3390/microorganisms11061369
Valladales-Restrepo LF, Aristizábal-Carmona BS, Giraldo-Correa JA, Acevedo-Medina LF, Valencia-Sánchez L, Acevedo-López DT, Gaviria-Mendoza A, Machado-Duque ME, Machado-Alba JE. Antibiotic Management of Uncomplicated Skin and Soft Tissue Infections in the Real World. Microorganisms. 2023; 11(6):1369. https://doi.org/10.3390/microorganisms11061369
Chicago/Turabian StyleValladales-Restrepo, Luis Fernando, Brayan Stiven Aristizábal-Carmona, Jaime Andrés Giraldo-Correa, Luis Felipe Acevedo-Medina, Laura Valencia-Sánchez, Doménica Tatiana Acevedo-López, Andrés Gaviria-Mendoza, Manuel Enrique Machado-Duque, and Jorge Enrique Machado-Alba. 2023. "Antibiotic Management of Uncomplicated Skin and Soft Tissue Infections in the Real World" Microorganisms 11, no. 6: 1369. https://doi.org/10.3390/microorganisms11061369
APA StyleValladales-Restrepo, L. F., Aristizábal-Carmona, B. S., Giraldo-Correa, J. A., Acevedo-Medina, L. F., Valencia-Sánchez, L., Acevedo-López, D. T., Gaviria-Mendoza, A., Machado-Duque, M. E., & Machado-Alba, J. E. (2023). Antibiotic Management of Uncomplicated Skin and Soft Tissue Infections in the Real World. Microorganisms, 11(6), 1369. https://doi.org/10.3390/microorganisms11061369