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Fig. 1. Temporal trends of antibiotic resistance for S. aureus SSIs in patients ≥18 years of age undergoing craniotomy, coronary artery bypass grafting, hysterectomy, C-section, colorectal surgery, spinal fusion, laminectomy, and hip and knee arthroplasty between 2012 and 2017. Trends in methicillin (P = .84), erythromy- cin (P = .18) and trimethoprime-sulfametoxazole (P = .63) resistance were not statistically signifi- cant; all other trends shown were significant (P < .01).
severe penicillin allergy, and its use has remained stable over recent years. We hypothesize that clindamycin use for the treatment of skin and soft-tissue infections likely contributes to the observed increase in clindamycin resistance. Other factorsmayhave contributed to the development of SASSIs,
such as suboptimal decolonization of SA in patients known to be SA carriers andsuboptimalpreoperative antibiotic dosing. SSI prevention guidelines recommend considering SA screening and decolonization in hospitals and populations with high S. aureus rates and high-risk procedures.5 In our hospital, patients are instructed to shower with a chlorhexidine agent prior to surgery, and preoperative SA screening with a decolonization protocol has been implemented for patients undergoing cardiac and orthopedic surgery. Although our study was conducted at a single center, many
patients undergoing surgery at our hospital come from different states. Furthermore, the observed trends in clindamycin resistance in SA SSIs are consistent with previous observations in SA nonsur- gical isolates.2,3 In summary, improving penicillin allergy documentation and consideration of alternatives to clindamycin in some circumstan- ces may prevent additional SA SSI cases.
Author ORCIDs. Valeria Fabre, 0000-0001-7374-9678
Inappropriate ceftriaxone use in outpatient acute respiratory infection management
Laura M. King MPH1 , Pamela Talley MD, MPH2, Marion A. Kainer MBBS, MPH2, Christopher D. Evans PharmD2,
Cullen Adre PharmD2, Lauri A. Hicks DO1 and Katherine E. Fleming-Dutra MD1 1Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia and 2Healthcare Associated Infections and Antimicrobial Resistance Program, Tennessee Department of Health, Nashville, Tennessee
Author for correspondence: Laura M. King, E-mail:
lfq0@cdc.gov Cite this article: King LM, et al. (2019). Inappropriate ceftriaxone use in outpatient
acute respiratory infection management. Infection Control & Hospital Epidemiology, 40: 487–490,
https://doi.org/10.1017/ice.2019.21
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
Ceftriaxone, a parenteral third-generation cephalosporin, is used to treat serious bacterial infections and sexually transmitted dis- eases.1 Inappropriate ceftriaxone use contributes to resistance to this important antibiotic and threatens patient safety due to antibiotic-associated adverse events and Clostridioides difficile
Financial support. No financial support was provided relevant to this article.
Conflicts of interest. A.M. reports consulting for Becton Dickinson. S.E.C. reports consulting for Theravance and Novartis. All other authors report no conflicts of interest relevant to this article.
References
1. Blumenthal KG, Ryan EE, Li Y, Lee H, Kuhlen JL, Shenoy ES. The impact of a reported penicillin allergy on surgical site infection risk. Clin Infect Dis 2018;66:329–336.
2. Acree ME, Morgan E, David MZ. S. aureus infections in Chicago, 2006–2014: increase in CA MSSA and decrease in MRSA incidence. Infect Control Hosp Epidemiol 2017;38:1226–1234.
3. Khamash DF, Voskertchian A, Tamma PD, Akinboyo IC, Carroll KC, Milstone AM. Increasing clindamycin and trimethoprim-sulfamethoxazole resistance in pediatric Staphylococcus aureus infections. J Pediatric Infect Dis Soc 2018. doi: 10.1093/jpids/piy062 [Epub ahead of print].
4. Shah NS, Ridgway JP, Pettit N, Fahrenbach J, Robicsek A. Documenting pen- icillin allergy: the impact of inconsistency. PLoS One 2016;11(3):e0150514.
5. Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent sur- gical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605–627.
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