Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria
Introducción: Las infecciones de piel y tejidos blandos (IPTB) son frecuente motivo de consulta ambulatoria. El estudio de los factores relacionados con no adecuación antibiótica en IPTB constituye el punto inicial para enfrentar a la resistencia bacteriana. Objetivo: Relacionar los factores de las IPTB no purulentas en pacientes adultos ambulatorios con prescripción inadecuada de antibioticoterapia en una IPS de Palmira en el año 2019. Métodos: Estudio transversal analítico retrospectivo. Se usó muestreo aleatorio simple. Se recolectó información de historias clínicas. El tratamiento antibiótico se consideró adecuado si fue acorde a guías. Se realizó estadística descriptiva de todas las variables, posteriormente se realizaron comparaciones... Ver más
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Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria Fernández-Urrusuno R, Flores-Dorado M, Vilches-Arenas A, Serrano-Martino C, Corral-Baena S, Montero-Balosa MC. Adecuación de la prescripción de antibióticos en un área de atención primaria: estudio descriptivo transversal. Enferm Infecc Microbiol Clin[Internet]. 2014; 32(5):285-92. Available from: http://dx.doi.org/10.1016/j.eimc.2013.05.004 Rath E, Skrede S, Oppegaard O, Bruun T. Non-purulent skin and soft tissue infections: predictive power of a severity score and the appropriateness of treatment in a prospective cohort. Infect Dis (Auckl) [Internet]. 2020; 0(0):1-11. Available from: https://doi.org/10.1080/23744235.2020.1726447 Haran J, Wu G, Bucci V, Fischer A, Boyer E, Hibberd P. Treatment of bacterial skin infections in ED observation units: Factors influencing prescribing practice. Am J Emerg Med [Internet]. 2015; 33(12):1780-5. Available from: http://dx.doi.org/10.1016/j.ajem.2015.08.035 Barlam TF, Cosgrove SE, Abbo LM, Macdougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016; 62(10):e51-77. Valderrama-Beltrán S, Gualtero S, Álvarez-Moreno C, Gil F, Ruiz AJ, Rodríguez JY, et al. Risk factors associated with methicillin-resistant Staphylococcus aureus skin and soft tissue infections in hospitalized patients in Colombia. Int J Infect Dis [Internet]. 2019; 87:60-6. Available from: https://www.ijidonline.com/article/S1201-9712(19)30292-9/fulltext Macía-Rodríguez C, Alende-Castro V, Vazquez-Ledo L, Novo-Veleiro I, González-Quintela A. Skin and soft-tissue infections: Factors associated with mortality and re-admissions. Enferm Infecc Microbiol Clin (English ed) [Internet]. 2017; 35(2):76-81. Available from: http://dx.doi.org/10.1016/j.eimce.2017.01.028 Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis. 2008; 47(6):735–43. Higuita-Gutiérrez L, Molina-Garcia V, Acevedo Guiral J, Gómez Cadena L, Roncancio G, Jiménez J. Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: A cross-sectional study. BMC Med Educ. 2020; 20(1):22. Haran J, Goulding M, Campion M, Scully G, Chandra A, Goldberg R, et al. Reduction of Inappropriate Antibiotic Use and Improved Outcomes by Implementation of an Algorithm-Based Clinical Guideline for Nonpurulent Skin and Soft Tissue Infections. Ann Emerg Med [Internet]. 2020; 0(0):1-11. Available from: https://doi.org/10.1016/j.annemergmed.2019.12.012 Hansen M, Arpi M, Hedin K, Melander E, Hertz F, Thorsted A, et al. Antibiotic-prescribing and antibiotic-resistance patterns among elderly citizens residing in two Nordic regions. Infect Dis (Auckl) [Internet]. 2020; 52(4):257-65. Available from: https://doi.org/10.1080/23744235.2019.1711159 Pulia M, Kern M, Schwei R, Shah M, Sampene E, Crnich C. Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: A cross-sectional analysis. Antimicrob Resist Infect Control [Internet]. 2018; 7(74):1-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000953/ O’Keefe C, Thompson A, McKenzie D, Lee K. Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior-to-hospital therapy. Int J Clin Pract [Internet]. 2019; 00:e13427. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/ijcp.13427 Jeong D, Nguyen H, Tyndall M, Schreiber Y. Antibiotic use among twelve Canadian First Nations communities: A retrospective chart review of skin and soft tissue infections. BMC Infect Dis [Internet]. 2020; 20(1):118. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011559/ Shively NR, Buehrle DJ, Clancy CJ, Decker BK. Prevalence of inappropriate antibiotic prescribing in primary care clinics within a veterans affairs health care system. Antimicrob Agents Chemother [Internet]. 2018; 62(8):1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105840/pdf/e00337-18.pdf Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM, et al. Prevalence of inappropriate antibiotic prescriptions among us ambulatory care visits, 2010-2011. JAMA - J Am Med Assoc [Internet]. 2016; 315(17):1864-73. Available from: https://jamanetwork.com/journals/jama/fullarticle/2518263 Broek A, Hest R, Lettinga K, Jimmink A, Lauw F, Visser C, et al. The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands. Antimicrob Resist Infect Control [Internet]. 2020; 9(1):40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036246/ Lipsky B, Napolitano L, Moran G, Vo L, Nicholson S, Kim M. Inappropriate initial antibiotic treatment for complicated skin and soft tissue infections in hospitalized patients: Incidence and associated factors. Diagn Microbiol Infect Dis [Internet]. 2014; 79(2):273-9. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0732889314000741?via %3Dihub Goss F, Bookman K, Barron M, Bickley D, Landgren B, Kroehl M, et al. Improved antibiotic prescribing using indication based clinical decision support in the emergency department. J Am Coll Emerg Physicians Open [Internet]. 2020; 1(3):214-21. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/emp2.12029 Fritz S, Shapiro D, Hersh A. National Trends in Incidence of Purulent Skin and Soft Tissue Infections in Patients Presenting to Ambulatory and Emergency Department Settings, 2000-2015. Clin Infect Dis [Internet]. 2019; 0(0):pii: ciz977. Available from: https://academic.oup.com/cid/advance-articleabstract/doi/10.1093/cid/ciz977/5586461?redirectedFrom=fulltext http://purl.org/coar/resource_type/c_6501 Text http://purl.org/coar/access_right/c_abf2 info:eu-repo/semantics/openAccess http://purl.org/coar/version/c_970fb48d4fbd8a85 info:eu-repo/semantics/publishedVersion http://purl.org/redcol/resource_type/ART http://purl.org/coar/resource_type/c_2df8fbb1 info:eu-repo/semantics/article Stevens D, Bisno A, Chambers H, Dellinger E, Goldstein E, Gorbach S, et al. Executive summary: Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis [Internet]. 2014; 59(2):147-59. Available from: https://academic.oup.com/cid/article/59/2/e10/2895845 Nickerson E, West T, Day N, Peacock S. Staphylococcus aureus disease and drug resistance in resource-limited countries in south and east Asia. Lancet Infect Dis [Internet]. 2009; 9(2):130-5. Available from: http://dx.doi.org/10.1016/S1473-3099(09)70022-2 Hurley H, Knepper B, Price C, Mehler P, Burman W, Jenkins T. Avoidable antibiotic exposure for uncomplicated skin and soft tissue infections in the ambulatory care setting. Am J Med [Internet]. 2013; 126(12):1099-106. Available from: http://dx.doi.org/10.1016/j.amjmed.2013.08.016 Sandoe J, Saeed K, Guleri A, Hand K, Dillon R, Allen M, et al. Opportunities for antimicrobial stewardship in patients with acute bacterial skin and skin structure infections who are unsuitable for beta-lactam antibiotics: a multicenter prospective observational study. Ther Adv Infect Dis [Internet]. 2019; 6:204993611882365. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365991/ Sutton J, Carico R, Burk M, Jones M, Wei X, Neuhauser M, et al. Inpatient Management of Uncomplicated Skin and Soft Tissue Infections in 34 Veterans Affairs Medical Centers: A Medication Use Evaluation. Open Forum Infect Dis [Internet]. 2020; 7(1):ofz554. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984672/ Haran J, Wilsterman E, Zeoli T, Goulding M, McLendon E, Clark M. Deviating from IDSA treatment guidelines for non-purulent skin infections increases the risk of treatment failure in emergency department patients. Epidemiol Infect [Internet]. 2019; 5:-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518578/ Walsh T, Chan L, Konopka C, Burkitt M, Moffa M, Bremmer D, et al. Appropriateness of antibiotic management of uncomplicated skin and soft tissue infections in hospitalized adult patients. BMC Infect Dis [Internet]. 2016; 16(1):1-8. Available from: http://dx.doi.org/10.1186/s12879-016-2067-0 Kwak Y, Choi S, Kim T, Park S, Seo S, Kim M, et al. Clinical guidelines for the antibiotic treatment for community-acquired skin and soft tissue infection. Infect Chemother [Internet]. 2017; 49(4):301-25. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754343/ Castrillón-Spitia J, Ocampo-Palacio A, Rivera-Echeverry C, Londoño-Montes J, Martínez-Betancur S, Machado-Alba J. Prescription of antibiotics in infections of the skin and soft tissues. Ces Med [Internet]. 2018; 32(1):3-13. Available from: http://revistas.ces.edu.co/index.php/medicina/article/view/4015 Yadav K, Nath A, Suh K, Sikora L, Eagles D. Treatment failure definitions for non-purulent skin and soft tissue infections: a systematic review. Infection [Internet]. 2020; 48(1):75-83. Available from: https://doi.org/10.1007/s15010-019-01347-w Publication Artículo de revista Introducción: Las infecciones de piel y tejidos blandos (IPTB) son frecuente motivo de consulta ambulatoria. El estudio de los factores relacionados con no adecuación antibiótica en IPTB constituye el punto inicial para enfrentar a la resistencia bacteriana. Objetivo: Relacionar los factores de las IPTB no purulentas en pacientes adultos ambulatorios con prescripción inadecuada de antibioticoterapia en una IPS de Palmira en el año 2019. Métodos: Estudio transversal analítico retrospectivo. Se usó muestreo aleatorio simple. Se recolectó información de historias clínicas. El tratamiento antibiótico se consideró adecuado si fue acorde a guías. Se realizó estadística descriptiva de todas las variables, posteriormente se realizaron comparaciones de grupos según sí la terapia antibiótica fue adecuada o no; finalmente, se realizó análisis multivariado para control de confusión. Resultados: Para una muestra de 213 historias clínicas el antibiótico más prescrito fue cefalexina (37,1 %); se encuentra una automedicación antibiótica (13,1 %) y 76,1 % de las prescripciones fueron adecuadas. En el análisis multivariante, la automedicación antibiótica (OR 17,523, IC 95 % 1,127-272,5) y la vía intramuscular (OR 44,358, IC 95 % 1,161-1695,461) se relacionaron con prescripción antibiótica no adecuada. Conclusión: Se recomienda la implementación de guías locales en servicios médicos ambulatorios con afianzamiento en sus directrices y la educación a comunidad respecto a la automedicación antibiótica desde la atención primaria para disminuir la no adecuación de la terapia antibiótica. Risueño Blanco, José Alirio infecciones de los tejidos blandos prescripción inadecuada antibacterianos automedicación atención ambulatoria guía de práctica clínica 18 2 Yunquera-Romero L, Márquez-Gómez I, Henares-López A, Morales-Lara M, Gallego Fernández C, Asensi-Díez R. Appropriateness of antimicrobial prescriptions in the emergency department of a tertiary hospital. Rev Española Quimioter [Internet]. 2018; 31(3):209-16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29771104 Núm. 2 , Año 2019 : Julio - Diciembre application/pdf Valderrama-Beltrán S, Cortés J, Caro M, Cely-Andrade L, Osorio-Pinzón J, Gualtero S, et al. Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections in Colombia. Infectio [Internet]. 2019; 23(4):318-46. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0123-93922019000400318 https://creativecommons.org/licenses/by-nc-sa/4.0/ Universidad de Caldas Biosalud Español https://revistasojs.ucaldas.edu.co/index.php/biosalud/article/view/8516 antibacterials Introduction: Skin and soft tissue infections (SSTIs) are a frequent reason for outpatient consultation. The study of the factors related to antibiotic inadequacy in SSTI constitutes the starting point to face bacterial resistance. Objective: Relate the factors of non-purulent STI in adult outpatients with inadequate prescription of antibiotic therapy in an IPS in Palmira in 2019. Methods: Retrospective analytical cross-sectional study. Simple random sampling was used. Information was collected from medical records. Antibiotic treatment was considered adequate if it was in accordance with the guidelines. Descriptive statistics of all the variables were performed, then group comparisons were made according to whether the antibiotic therapy was adequate or not; Finally, multivariate analysis was performed to control for confusion. Results: For a sample of 213 medical records, the most prescribed antibiotic was cephalexin (37.1 %); antibiotic self-medication is found (13.1 %) and 76.1 % of the prescriptions were adequate. In the multivariate analysis, antibiotic self-medication (OR 17.523, 95 % CI 1.127-272.5) and the intramuscular route (OR 44.358, 95 % CI 1.161-1695.461) were related to inappropriate antibiotic prescription. Conclusion: The implementation of local guidelines in outpatient medical services is recommended, strengthening their guidelines and educating the community regarding antibiotic self-medication from primary care to reduce the inappropriateness of antibiotic therapy. soft tissue infections inappropriate prescription self-medication outpatient care clinical practice guideline Journal article Factors related to the inappropriate prescription of antibiotic therapy in adults with skin infections in outpatient clinics 2023-12-14 https://revistasojs.ucaldas.edu.co/index.php/biosalud/article/download/8516/6983 2462-960X 10.17151/biosa.2019.18.2.1 https://doi.org/10.17151/biosa.2019.18.2.1 1657-9550 7 18 2023-12-14T11:57:37Z 2023-12-14T11:57:37Z |
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UNIVERSIDAD DE CALDAS |
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https://nuevo.metarevistas.org/UNIVERSIDADDECALDAS/logo.png |
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Colombia |
| collection |
Biosalud |
| title |
Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria |
| spellingShingle |
Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria Risueño Blanco, José Alirio infecciones de los tejidos blandos prescripción inadecuada antibacterianos automedicación atención ambulatoria guía de práctica clínica antibacterials soft tissue infections inappropriate prescription self-medication outpatient care clinical practice guideline |
| title_short |
Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria |
| title_full |
Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria |
| title_fullStr |
Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria |
| title_full_unstemmed |
Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria |
| title_sort |
factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria |
| title_eng |
Factors related to the inappropriate prescription of antibiotic therapy in adults with skin infections in outpatient clinics |
| description |
Introducción: Las infecciones de piel y tejidos blandos (IPTB) son frecuente motivo de consulta ambulatoria. El estudio de los factores relacionados con no adecuación antibiótica en IPTB constituye el punto inicial para enfrentar a la resistencia bacteriana. Objetivo: Relacionar los factores de las IPTB no purulentas en pacientes adultos ambulatorios con prescripción inadecuada de antibioticoterapia en una IPS de Palmira en el año 2019. Métodos: Estudio transversal analítico retrospectivo. Se usó muestreo aleatorio simple. Se recolectó información de historias clínicas. El tratamiento antibiótico se consideró adecuado si fue acorde a guías. Se realizó estadística descriptiva de todas las variables, posteriormente se realizaron comparaciones de grupos según sí la terapia antibiótica fue adecuada o no; finalmente, se realizó análisis multivariado para control de confusión. Resultados: Para una muestra de 213 historias clínicas el antibiótico más prescrito fue cefalexina (37,1 %); se encuentra una automedicación antibiótica (13,1 %) y 76,1 % de las prescripciones fueron adecuadas. En el análisis multivariante, la automedicación antibiótica (OR 17,523, IC 95 % 1,127-272,5) y la vía intramuscular (OR 44,358, IC 95 % 1,161-1695,461) se relacionaron con prescripción antibiótica no adecuada. Conclusión: Se recomienda la implementación de guías locales en servicios médicos ambulatorios con afianzamiento en sus directrices y la educación a comunidad respecto a la automedicación antibiótica desde la atención primaria para disminuir la no adecuación de la terapia antibiótica.
|
| description_eng |
Introduction: Skin and soft tissue infections (SSTIs) are a frequent reason for outpatient consultation. The study of the factors related to antibiotic inadequacy in SSTI constitutes the starting point to face bacterial resistance. Objective: Relate the factors of non-purulent STI in adult outpatients with inadequate prescription of antibiotic therapy in an IPS in Palmira in 2019. Methods: Retrospective analytical cross-sectional study. Simple random sampling was used. Information was collected from medical records. Antibiotic treatment was considered adequate if it was in accordance with the guidelines. Descriptive statistics of all the variables were performed, then group comparisons were made according to whether the antibiotic therapy was adequate or not; Finally, multivariate analysis was performed to control for confusion. Results: For a sample of 213 medical records, the most prescribed antibiotic was cephalexin (37.1 %); antibiotic self-medication is found (13.1 %) and 76.1 % of the prescriptions were adequate. In the multivariate analysis, antibiotic self-medication (OR 17.523, 95 % CI 1.127-272.5) and the intramuscular route (OR 44.358, 95 % CI 1.161-1695.461) were related to inappropriate antibiotic prescription. Conclusion: The implementation of local guidelines in outpatient medical services is recommended, strengthening their guidelines and educating the community regarding antibiotic self-medication from primary care to reduce the inappropriateness of antibiotic therapy.
|
| author |
Risueño Blanco, José Alirio |
| author_facet |
Risueño Blanco, José Alirio |
| topicspa_str_mv |
infecciones de los tejidos blandos prescripción inadecuada antibacterianos automedicación atención ambulatoria guía de práctica clínica |
| topic |
infecciones de los tejidos blandos prescripción inadecuada antibacterianos automedicación atención ambulatoria guía de práctica clínica antibacterials soft tissue infections inappropriate prescription self-medication outpatient care clinical practice guideline |
| topic_facet |
infecciones de los tejidos blandos prescripción inadecuada antibacterianos automedicación atención ambulatoria guía de práctica clínica antibacterials soft tissue infections inappropriate prescription self-medication outpatient care clinical practice guideline |
| citationvolume |
18 |
| citationissue |
2 |
| citationedition |
Núm. 2 , Año 2019 : Julio - Diciembre |
| publisher |
Universidad de Caldas |
| ispartofjournal |
Biosalud |
| source |
https://revistasojs.ucaldas.edu.co/index.php/biosalud/article/view/8516 |
| language |
Español |
| format |
Article |
| rights |
http://purl.org/coar/access_right/c_abf2 info:eu-repo/semantics/openAccess https://creativecommons.org/licenses/by-nc-sa/4.0/ |
| references |
Fernández-Urrusuno R, Flores-Dorado M, Vilches-Arenas A, Serrano-Martino C, Corral-Baena S, Montero-Balosa MC. Adecuación de la prescripción de antibióticos en un área de atención primaria: estudio descriptivo transversal. Enferm Infecc Microbiol Clin[Internet]. 2014; 32(5):285-92. Available from: http://dx.doi.org/10.1016/j.eimc.2013.05.004 Rath E, Skrede S, Oppegaard O, Bruun T. Non-purulent skin and soft tissue infections: predictive power of a severity score and the appropriateness of treatment in a prospective cohort. Infect Dis (Auckl) [Internet]. 2020; 0(0):1-11. Available from: https://doi.org/10.1080/23744235.2020.1726447 Haran J, Wu G, Bucci V, Fischer A, Boyer E, Hibberd P. Treatment of bacterial skin infections in ED observation units: Factors influencing prescribing practice. Am J Emerg Med [Internet]. 2015; 33(12):1780-5. Available from: http://dx.doi.org/10.1016/j.ajem.2015.08.035 Barlam TF, Cosgrove SE, Abbo LM, Macdougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016; 62(10):e51-77. Valderrama-Beltrán S, Gualtero S, Álvarez-Moreno C, Gil F, Ruiz AJ, Rodríguez JY, et al. Risk factors associated with methicillin-resistant Staphylococcus aureus skin and soft tissue infections in hospitalized patients in Colombia. Int J Infect Dis [Internet]. 2019; 87:60-6. Available from: https://www.ijidonline.com/article/S1201-9712(19)30292-9/fulltext Macía-Rodríguez C, Alende-Castro V, Vazquez-Ledo L, Novo-Veleiro I, González-Quintela A. Skin and soft-tissue infections: Factors associated with mortality and re-admissions. Enferm Infecc Microbiol Clin (English ed) [Internet]. 2017; 35(2):76-81. Available from: http://dx.doi.org/10.1016/j.eimce.2017.01.028 Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis. 2008; 47(6):735–43. Higuita-Gutiérrez L, Molina-Garcia V, Acevedo Guiral J, Gómez Cadena L, Roncancio G, Jiménez J. Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: A cross-sectional study. BMC Med Educ. 2020; 20(1):22. Haran J, Goulding M, Campion M, Scully G, Chandra A, Goldberg R, et al. Reduction of Inappropriate Antibiotic Use and Improved Outcomes by Implementation of an Algorithm-Based Clinical Guideline for Nonpurulent Skin and Soft Tissue Infections. Ann Emerg Med [Internet]. 2020; 0(0):1-11. Available from: https://doi.org/10.1016/j.annemergmed.2019.12.012 Hansen M, Arpi M, Hedin K, Melander E, Hertz F, Thorsted A, et al. Antibiotic-prescribing and antibiotic-resistance patterns among elderly citizens residing in two Nordic regions. Infect Dis (Auckl) [Internet]. 2020; 52(4):257-65. Available from: https://doi.org/10.1080/23744235.2019.1711159 Pulia M, Kern M, Schwei R, Shah M, Sampene E, Crnich C. Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: A cross-sectional analysis. Antimicrob Resist Infect Control [Internet]. 2018; 7(74):1-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000953/ O’Keefe C, Thompson A, McKenzie D, Lee K. Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior-to-hospital therapy. Int J Clin Pract [Internet]. 2019; 00:e13427. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/ijcp.13427 Jeong D, Nguyen H, Tyndall M, Schreiber Y. Antibiotic use among twelve Canadian First Nations communities: A retrospective chart review of skin and soft tissue infections. BMC Infect Dis [Internet]. 2020; 20(1):118. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011559/ Shively NR, Buehrle DJ, Clancy CJ, Decker BK. Prevalence of inappropriate antibiotic prescribing in primary care clinics within a veterans affairs health care system. Antimicrob Agents Chemother [Internet]. 2018; 62(8):1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105840/pdf/e00337-18.pdf Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM, et al. Prevalence of inappropriate antibiotic prescriptions among us ambulatory care visits, 2010-2011. JAMA - J Am Med Assoc [Internet]. 2016; 315(17):1864-73. Available from: https://jamanetwork.com/journals/jama/fullarticle/2518263 Broek A, Hest R, Lettinga K, Jimmink A, Lauw F, Visser C, et al. The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands. Antimicrob Resist Infect Control [Internet]. 2020; 9(1):40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036246/ Lipsky B, Napolitano L, Moran G, Vo L, Nicholson S, Kim M. Inappropriate initial antibiotic treatment for complicated skin and soft tissue infections in hospitalized patients: Incidence and associated factors. Diagn Microbiol Infect Dis [Internet]. 2014; 79(2):273-9. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0732889314000741?via %3Dihub Goss F, Bookman K, Barron M, Bickley D, Landgren B, Kroehl M, et al. Improved antibiotic prescribing using indication based clinical decision support in the emergency department. J Am Coll Emerg Physicians Open [Internet]. 2020; 1(3):214-21. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/emp2.12029 Fritz S, Shapiro D, Hersh A. National Trends in Incidence of Purulent Skin and Soft Tissue Infections in Patients Presenting to Ambulatory and Emergency Department Settings, 2000-2015. Clin Infect Dis [Internet]. 2019; 0(0):pii: ciz977. 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