Early-switch/early-discharge opportunities for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections: proof of concept in the United Arab Emirates

Figures & data

Table 1 Patient and disease characteristics

	All UAE patients (N=24)	IV-to-PO switch (N=5)	IV-only (N=19)
Age, mean ± SD	50.2±16.1	54.2±16.3	49.1 ± 16.3
Male, n (%)	11 (45.8%)	1 (20.0%)	10 (52.6%)
Asian, n (%)	22 (91.7%)	3 (60.0%)	19 (100.0%)
Charlson Comorbidity	2.2±2.9	2.2±2.9	2.2±2.9
Index, mean ± SD
Primary reason for hospitalization is treatment of MRSA cSSTI, n (%)	16 (66.7%)	4 (80.0%)	12 (63.2%)
Timing of cSSTI diagnosis, n (%)
At hospital admission	16 (66.7%)	4 (80.0%)	12 (63.2%)
1–3 days after admission	2 (8.3%)	0 (0.0%)	2 (10.5%)
4+ days after admission	6 (25.0%)	1 (20.0%)	5 (26.3%)
Type of cSSTI, n (%)
Surgical site infection	10 (41.7%)	2 (40.0%)	8 (42.1%)
Major abscess	12 (50.0%)	3 (60.0%)	9 (47.4%)
Deep/extensive cellulitis	2 (8.3%)	0 (0.0%)	2 (10.5%)
cSSTI location, n (%)
Head/skull/neck	3 (12.5%)	0 (0.0%)	3 (15.8%)
Torso/abdomen	16 (66.7%)	5 (100.0%)	11 (57.9%)
Upper extremity	1 (4.2%)	0 (0.0%)	1 (5.3%)
Lower extremity	4 (16.7%)	0 (0.0%)	4 (21.1%)
Sepsis, severe sepsis, or septic shock during cSSTI episode, n (%)	0 (0.0%)	0 (0.0%)	0 (0.0%)

Abbreviations: cSSTI, complicated skin and soft tissue infection; IV, intravenous; MRSA, Methicillin-resistant Staphylococcus aureus; PO, oral; SD, standard deviation; UAE, United Arab Emirates.

Table 2 Actual antibiotic and health care resource use

	All UAE patients (N=24)	IV-to-PO switch (N=5)	IV-only (N=19)
Number of MRSA-targeted lines of therapy, n(%)
1	16 (66.7%)	0 (0.0%)	16 (84.2%)
2	5 (20.8%)	3 (60.0%)	2 (10.5%)
3	3 (12.5%)	2 (40.0%)	1 (5.3%)
MRSA-active length of therapy (including PO), mean ± SD	10.8±7.0	12.6±7.4	10.4±7.1
MRSA-active IV days, mean (SD)	9.8±6.6	7.4±4.6	10.4±7.1
MRSA-targeted antibiotics used in initial line, n (%)
Clindamycin IV	4 (16.7%)	2 (40.0%)	2 (10.5%)
Linezolid IV	4 (16.7%)	0 (0.0%)	4 (21.1%)
Meropenem IV	1 (4.2%)	0 (0.0%)	1 (5.3%)
Teicoplanin IV	2 (8.3%)	0 (0.0%)	2 (10.5%)
Tigecycline IV	1 (4.2%)	1 (20.0%)	0 (0.0%)
Vancomycin IV	8 (33.3%)	2 (40.0%)	6 (31.6%)
Tigecycline IV + Vancomycin IV	1 (4.2%)	0 (0.0%)	1 (5.3%)
MRSA-targeted antibiotics used in last line, n (%)
Clindamycin IV	2 (8.3%)	0 (0.0%)	2 (10.5%)
Clindamycin PO	1 (4.2%)	1 (20.0%)	0 (0.0%)
Linezolid IV	5 (20.8%)	0 (0.0%)	5 (26.3%)
Linezolid PO	3 (12.5%)	3 (60.0%)	0 (0.0%)
Meropenem IV	1 (4.2%)	0 (0.0%)	1 (5.3%)
TMP/SMX PO	1 (4.2%)	1 (20.0%)	0 (0.0.%)
Teicoplanin IV	2 (8.3%)	0 (0.0%)	2 (10.5%)
Tigecycline IV	2 (8.3%)	0 (0.0%)	2 (10.5%)
Vancomycin IV	6 (25%)	0 (0.0%)	6 (31.6%)
Tigecycline IV + Vancomycin IV	1 (4.2%)	0 (0.0%)	1 (5.3%)
MRSA-targeted antibiotics prescribed at discharge	8 (33.3%)	3 (60%)	5 (26.3%)
Ciprofloxacin POa	1 (12.5%)	0 (0.0%)	1 (20%)
Clindamycin POa	1 (12.5%)	1 (33.3%)	0 (0.0%)
Doxycycline POa	1 (12.5%)	0 (0.0%)	1 (20.0%)
Linezolid POa	3 (37.5%)	1 (33.3%)	2 (40.0%)
Trimethoprim POa	1 (12.5%)	1 (33.3%)	0 (0.0%)
TMP/SMX POa	1 (12.5%)	0 (0.0%)	1 (20.0%)
LOS, days from cSSTI index through discharge, mean (SD)	13.9±9.3	14.2±7.6	13.8±9.8
Regular ward days, mean (SD)	10.3±8.9	14.2±7.6	9.3±9.1
High dependency/intermediate care days, mean (SD)	2.9±8.3	0±0	3.6±9.3
Intensive care unit days, mean (SD)	0.6±3.1	0±0	0.8±3.4
Surgical procedures for cSSTI treatment, n (%)	21 (87.5%)	5 (100.0%)	16 (84.2%)
Total number of procedures among those with any procedures, mean ± SD	1.1 ±0.6	1.2±0.4	1.1 ±0.6

Note:

a Denominator is patients with any MRSA-targeted antibiotic prescribed at discharge.

Abbreviations: cSSTI, complicated skin and soft tissue infection; IV, intravenous; LOS, length of stay; MRSA, methicillin-resistant Staphylococcus aureus; PO, oral; SD, standard deviation; TMP/SMX, trimethoprim/sulfamethoxazole; UAE, United Arab Emirates.

Figure 1 Comparison of actual and hypothetical IV-line and bed days in ES- and ED-eligible patients.

Abbreviations: ED, early discharge; ES, early switch; IV, intravenous.