UMMS Affiliation

Department of Emergency Medicine; Department of Quantitative Health Sciences

Publication Date


Document Type



Bacterial Infections and Mycoses | Clinical Epidemiology | Emergency Medicine | Epidemiology | Geriatrics | Health Services Administration | Infectious Disease | Skin and Connective Tissue Diseases


The Infectious Disease Society of America (IDSA) publishes guidelines regularly for the management of skin and soft tissue infections; however, the extent to which practice patterns follow these guidelines and if this can affect treatment failure rates is unknown. We observed the treatment failure rates from a multicentre retrospective ambulatory cohort of adult emergency department patients treated for a non-purulent skin infection. We used multivariable logistic regression to examine the role of IDSA classification and whether adherence to IDSA guidelines reduced treatment failure. A total of 759 ambulatory patients were included in the cohort with 17.4% failing treatment. Among all patients, 56.0% had received treatments matched to the IDSA guidelines with 29.1% over-treated, and 14.9% under-treated based on the guidelines. After adjustment for age, gender, infection location and medical comorbidities, patients with a moderate infection type had three times increased risk of treatment failure (adjusted risk ratio (aRR) 2.98; 95% confidence interval (CI) 1.15-7.74) and two times increased risk with a severe infection type (aRR 2.27; 95% CI 1.25-4.13) compared with mild infection types. Patients who were under-treated based on IDSA guidelines were over two times more likely to fail treatment (aRR 2.65; 95% CI 1.16-6.05) while over-treatment was not associated with treatment failure. Patients 70 years of age had a 56% increased risk of treatment failure (aRR 1.56; 95% CI 1.04-2.33) compared with those < 70 years. Following the IDSA guidelines for non-purulent SSTIs may reduce the treatment failure rates; however, older adults still carry an increased risk of treatment failure.


Antibiotics, elderly, infectious disease, skin infections

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COPYRIGHT: © The Author(s) 2018. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

DOI of Published Version



Epidemiol Infect. 2018 Dec 5;147:e68. doi: 10.1017/S0950268818003291. Link to article on publisher's site

Journal/Book/Conference Title

Epidemiology and infection

PubMed ID


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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.