Acute Bacterial Skin and Skin Structure Infections (ABSSSI): Practice Guidelines for Management and Care Transitions in the Emergency Department and Hospital

• Published in: The Journal of emergency medicine Vol. 48; no. 4; pp. 508 - 519
• Main Authors: Pollack, Charles V., MA, MD, Amin, Alpesh, MD, MBA, Ford, William T., MD, SFHM, Finley, Richard, MD, Kaye, Keith S., MD, MPH, Nguyen, Hien H., MD, MS, Rybak, Michael J., PharmD, MPH, Talan, David, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2015
• Subjects: ABSSSI; Acute Disease; Anti-Bacterial Agents - therapeutic use; antibiotics; best practice; Continuity of Patient Care; Cost of Illness; Disease Management; Emergency; Emergency Service, Hospital; Humans; Practice Guidelines as Topic; processes of care; Skin Diseases, Bacterial - drug therapy; skin infections; ABSSSI; antibiotics; skin infections; processes of care; best practice
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2014.12.001

Abstract Background Acute bacterial skin and skin structure infections (ABSSSI), formally referred to as complicated skin and soft tissue infections, include infections with resistance to previously effective antimicrobials. Increasing dramatically in incidence, they have become a challenging medical problem associated with high direct and indirect costs to both the medical system and society. Objectives To describe the burden of ABSSSI and to explore multidisciplinary approaches to its management and new treatments that can be initiated in the emergency department. Discussion We offer a best practice model aimed at providing risk-stratified and convenient care for ABSSSI at the lowest possible cost, while minimizing complications, readmissions, and inappropriate antibiotic use. In doing so, we focus on the care provided by emergency physicians and hospitalists and the transition of management between them for inpatient care, as well as the facilitation of observation or direct-to-outpatient care for suitable patients. Conclusions A standard, consistent, and multidisciplinary approach to ABSSSI can streamline care, reduce admissions, support antimicrobial stewardship, and improve clinical and resource consumption outcomes.