{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T07:29:47Z","timestamp":1773732587935,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,7,4]],"date-time":"2018-07-04T00:00:00Z","timestamp":1530662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Current guideline recommendations for optimal management of nonpurulent skin and soft tissue infections (<jats:styled-content style=\"fixed-case\">SSTI<\/jats:styled-content>s) are based on expert consensus. There is a lack of evidence to guide emergency physicians regarding selection of patients for oral versus intravenous antibiotic therapy. The primary objective was to identify predictors associated with oral antibiotic treatment failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a health records review of adults (age \u2265\u00a018 years) with nonpurulent <jats:styled-content style=\"fixed-case\">SSTI<\/jats:styled-content>s treated at two tertiary care emergency departments (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s). Oral antibiotic treatment failure was defined as any of the following after a minimum of 48 hours of oral therapy due to worsening infection: 1) hospitalization, 2) change in class of oral antibiotic, or 3) switch to intravenous therapy. Multivariable logistic regression was used to identify predictors independently associated with oral antibiotic treatment failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 500 patients (mean\u00a0\u00b1\u00a0<jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> age\u00a0= 64\u00a0\u00b1\u00a019 years, 279 male [55.8%], and 126 [25.2%] with diabetes). Of 288 patients who had received a minimum of 48 hours of oral antibiotics, there were 85 oral antibiotic treatment failures (29.5%). Tachypnea at triage (odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>]\u00a0=\u00a06.31, 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]\u00a0=\u00a01.80 to 22.08), chronic ulcers (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\u00a0=\u00a04.90, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.68\u201314.27), history of methicillin\u2010resistant <jats:italic>Staphylococcus aureus<\/jats:italic> (<jats:styled-content style=\"fixed-case\">MRSA<\/jats:styled-content>) colonization or infection (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\u00a0=\u00a04.83, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.51 to 15.44), and cellulitis in the past 12 months (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\u00a0=\u00a02.23, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.01 to 4.96) were independently associated with oral antibiotic treatment failure<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the first study to evaluate predictors of oral antibiotic treatment failure for nonpurulent <jats:styled-content style=\"fixed-case\">SSTI<\/jats:styled-content>s treated in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>. Tachypnea at triage, chronic ulcers, history of <jats:styled-content style=\"fixed-case\">MRSA<\/jats:styled-content> colonization or infection, and cellulitis within the past year were independently associated with oral antibiotic treatment failure. Emergency physicians should consider these risk factors when deciding on oral versus intravenous antimicrobial therapy for outpatient management of nonpurulent <jats:styled-content style=\"fixed-case\">SSTI<\/jats:styled-content>s.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13492","type":"journal-article","created":{"date-parts":[[2018,6,5]],"date-time":"2018-06-05T08:40:14Z","timestamp":1528188014000},"page":"51-59","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Predictors of Oral Antibiotic Treatment Failure for Nonpurulent Skin and Soft Tissue Infections in the Emergency Department"],"prefix":"10.1111","volume":"26","author":[{"given":"Krishan","family":"Yadav","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Ottawa Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn N.","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Infectious Diseases University of Ottawa Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debra","family":"Eagles","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Ottawa Ottawa Ontario Canada"},{"name":"Emergency Medicine Research The Ottawa Hospital Research Institute University of Ottawa Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"MacIsaac","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Ottawa Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darmyn","family":"Ritchie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Ottawa Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Bernick","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Methods Centre University of Ottawa Heart Institute Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkatesh","family":"Thiruganasambandamoorthy","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Ottawa Ottawa Ontario Canada"},{"name":"Emergency Medicine Research The Ottawa Hospital Research Institute University of Ottawa Ottawa Ontario Canada"},{"name":"Department of Epidemiology and Community Medicine University of Ottawa Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Wells","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Community Medicine University of Ottawa Ottawa Ontario Canada"},{"name":"Cardiovascular Research Methods Centre University of Ottawa Heart Institute Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian G.","family":"Stiell","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Ottawa Ottawa Ontario Canada"},{"name":"Emergency Medicine Research The Ottawa Hospital Research Institute University of Ottawa Ottawa Ontario Canada"},{"name":"Department of Epidemiology and Community Medicine University of Ottawa Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,7,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.12.004"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2013.8.18040"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1481803500011623"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu296"},{"key":"e_1_2_11_6_1","unstructured":"Clinical Resource Efficiency Support Team.Guidelines on the Management of Cellulitis in Adults.Belfast:CREST 2005."},{"key":"e_1_2_11_7_1","unstructured":"Consensus Document on the Management of Cellulitis in Lymphoedema.Lichfield:British Lymphology Society 2016."},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001825"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/24.3.457"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.4103\/0976-500X.130042"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(96)70264-0"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2004.11.011"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2005.01.032"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.03.025"},{"key":"e_1_2_11_15_1","unstructured":"Guidance for Industry: Acute Bacterial Skin and Skin Structure Infections: Developing Drugs for Treatment. 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