The Relationship Between Adherence to Oral Antibiotics and Post-Discharge Clinical Outcomes Among Patients Hospitalized with Staphylococcus aureus Skin Infections.
Antimicrob Agents Chemother. 2016 Feb 29;
Authors: Eells SJ, Nguyen M, Jung J, Macias-Gil R, May L, Miller LG
Abstract
Skin and soft tissue infections (SSTIs) are common and frequently recur. Poor adherence to antibiotic therapy may lead to suboptimal clinical outcomes. However, adherence to oral antibiotic therapy for SSTIs and its relationship to clinical outcomes have not been examined. We enrolled adult patients hospitalized with uncomplicated SSTIs caused by S. aureus being discharged with oral antibiotics to complete therapy. We fit participants' pill bottle with an electronic bottle cap that recorded each pill bottle opening, administered an in-person standardized questionnaire at enrollment, 14 days, and 30 days, and reviewed participants' medical records to determine outcomes. Our primary outcomes was poor clinical response, defined as change in antibiotic therapy, new incision and drainage procedure, or a new skin infection within 30 days of hospital discharge. Of our 188 participants, 87 had complete data available for analysis. Among these participants, 40 (46%) had a poor clinical response to at 30 days. Mean electronically-measured adherence to antibiotic therapy was significantly different than self-reported adherence (57% vs. 96%, p<0.0001). In a multivariable model, poor clinical response at 30 days was associated with lower adherence, being non-diabetic, and lack of illicit drug use within the previous 12 months (p<0.05). In conclusion, we found patient adherence to oral antibiotic therapy for SSTI after hospital discharge was low (57%) and associated with poor clinical outcome. Patients commonly overstate their medication adherence, which may make identifying patients at risk for non-adherence and poor outcomes challenging. Further studies are needed to improve post-discharge antibiotic adherence after SSTIs.
PMID: 26926634 [PubMed - as supplied by publisher]