Background. Skin and soft tissue infections (SSTI) are a common presentation in the emergency department. The most common pathogens that cause SSTI are Staphylococcus aureus and Streptococcus pyogenes.
The IDSA guidelines for SSTI recommend that the empiric treatment for simple SSTI be treated with anti-staphylococcal penicillins or a first or second generation cephalosporin. Ertapenem may appear to be a good choice to treat SSTI due to its broad spectrum of activity against both gram positive and gram negative bacteria. However, the guidelines state that ertapenem should be saved for complicated infections or for infections caused by bacteria resistant to our first line options.
In 2011 a protocol for the treatment of SSTI in the emergency department was implemented at McKay- Dee Hospital in hopes of standardizing the approach to treating SSTI in the emergency department.
The primary outcome was to determine the effect the protocol has had on the use of ertapenem to treat SSTI in the emergency department. A relative decrease of 25% would show efficacy of the implemented protocol.
Methods. Using ICD9 codes, patients treated for SSTI in the emergency department immediately prior to and after the protocol was implemented were identified. The electronic medical record was then reviewed to determine what medication the patient received. The overall percentage use of ertapenem was determined for each group and evaluated using the chi squared test. In the 2007-2008 group 1298 patients were evaluated, 281 were excluded, 996 met the inclusion criteria. In the 2011-2012 group 1158 patients were evaluated, 163 were excluded, 995 met the inclusion criteria.
Results. In the 2007-2008 group 322 (32%) patients received ertapenem. In the 2011-2012 group 140 (14%) patients received ertapenem. The difference in ertapenem usage was found to be statistically significant (P <0.0001).
Conclusion. To maintain the effectiveness of ertapenem its use should be reserved for complicated SSTI or SSTI caused by bacteria resistant to first line options as recommended by the IDSA guidelines. Based on the data collected it appears that the protocol helped to decrease the use of ertapenem to treat SSTI in our emergency department.
Disclosures. All authors: No reported disclosures.