{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:28:26Z","timestamp":1760236106531,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,10,22]],"date-time":"2021-10-22T00:00:00Z","timestamp":1634860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1079625"],"award-info":[{"award-number":["APP1079625"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100015006","name":"Western Alliance","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100015006","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Despite the availability of evidence-based guidelines, antibiotics for cellulitis remain inappropriately prescribed. This evidence\u2013practice gap is more evident in low-resource settings, such as rural hospitals. This implementation study developed and introduced a cellulitis management plan to improve antibiotic prescribing for cellulitis in three health services in regional Australia. Appropriateness of antibiotic prescribing for cellulitis at Day 1 was the primary outcome measure. Adults with ICD-10-AM codes for lower-limb cellulitis admitted as inpatients of the three health services between May and November 2019 (baseline, n = 165) and March and October 2020 (post-implementation, n = 127) were included in the assessment. The uptake of the cellulitis management plan was 29.1% (37\/127). The appropriateness of antibiotic prescribing for cellulitis at Day 1 was similar at baseline (78.7%, 144\/183) and in the intention-to-treat post-implementation group (81.8%, 126\/154) [95% CI \u22125.6% to 11.3%, p = 0.50]. Commencement of the cellulitis management plan resulted in a non-statistically significant increase in antibiotic appropriateness at Day 1 compared to when a cellulitis management plan was not commenced (88.1% vs. 79.5%; 95% CI \u22125.6% to 19.8%; p = 0.20) Evaluation of more real-world strategies to address evidence\u2013practice gaps, such as the appropriateness of antibiotic prescribing for cellulitis, is required.<\/jats:p>","DOI":"10.3390\/antibiotics10111288","type":"journal-article","created":{"date-parts":[[2021,10,22]],"date-time":"2021-10-22T09:18:09Z","timestamp":1634894289000},"page":"1288","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence\u2013Practice Gap in Antibiotic Prescribing"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8988-2203","authenticated-orcid":false,"given":"Jaclyn","family":"Bishop","sequence":"first","affiliation":[{"name":"National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia"},{"name":"Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine- RMH, The University of Melbourne, Royal Parade, Melbourne, VIC 3000, Australia"},{"name":"Pharmacy Department, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Jones","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Farquharson","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Colac Area Health, Connor Street, Colac, VIC 3250, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathrine","family":"Summerhayes","sequence":"additional","affiliation":[{"name":"Clinical Improvement, Risk and Innovation, Wimmera Health Care Group, Baillie Street, Horsham, VIC 3400, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxanne","family":"Tucker","sequence":"additional","affiliation":[{"name":"Clinical Improvement, Risk and Innovation, Wimmera Health Care Group, Baillie Street, Horsham, VIC 3400, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Health and Human Services (Victoria), McLachlan Street, Horsham, VIC 3000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel","family":"Cowan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. Deborah","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Barwon Health, Ryrie Street, Geelong, VIC 3220, Australia"},{"name":"School of Medicine, Faculty of Health, Deakin University, Pigdons Road, Waurn Ponds, VIC 3216, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Schulz","sequence":"additional","affiliation":[{"name":"National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia"},{"name":"Victorian Infectious Diseases Service, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC 3050, Australia"},{"name":"Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, 792 Elizabeth Street, Melbourne, VIC 3000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Kong","sequence":"additional","affiliation":[{"name":"National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia"},{"name":"Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine- RMH, The University of Melbourne, Royal Parade, Melbourne, VIC 3000, Australia"},{"name":"Pharmacy Department, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, Australia"},{"name":"Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsty","family":"Buising","sequence":"additional","affiliation":[{"name":"National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia"},{"name":"Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine- RMH, The University of Melbourne, Royal Parade, Melbourne, VIC 3000, Australia"},{"name":"Victorian Infectious Diseases Service, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC 3050, Australia"},{"name":"Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, 792 Elizabeth Street, Melbourne, VIC 3000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1001\/jamadermatol.2018.4650","article-title":"Analysis of readmissions following hospitalization for cellulitis in the united states","volume":"155","author":"Fisher","year":"2019","journal-title":"JAMA Dermatol."},{"unstructured":"Australian Institute of Health and Welfare (2019). Potentially Preventable Hospitalisations in Australia by Age Groups and Small Geographic Areas, 2017\u20132018, AIHW.","key":"ref_2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s11845-019-02065-w","article-title":"Over-admission and over-treatment of patients with cellulitis: A 5-year audit against international guidelines","volume":"189","author":"Kiely","year":"2020","journal-title":"Ir. J. Med. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"ofz554","DOI":"10.1093\/ofid\/ofz554","article-title":"Inpatient management of uncomplicated skin and soft tissue infections in 34 veterans affairs medical centers: A medication use evaluation","volume":"7","author":"Sutton","year":"2020","journal-title":"Open Forum Infect. Dis."},{"unstructured":"Australian Commission on Safety and Quality in Health Care (2021). Aura 2021: Fourth Australian Report on Antimicrobial Use and Resistance in Human Health, ACSQHC.","key":"ref_5"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.ijantimicag.2018.10.009","article-title":"Similarities and differences in antimicrobial prescribing between australian major-city hospitals and regional and remote hospitals","volume":"53","author":"Bishop","year":"2019","journal-title":"Int. J. Antimicrob. Agents"},{"unstructured":"Antibiotic Expert Groups (2019). Therapeutic Guidelines: Antibiotic, Therapeutic Guidelines Limited. [16th ed.].","key":"ref_7"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1002\/jhm.2593","article-title":"Overtreatment of nonpurulent cellulitis","volume":"11","author":"Gunderson","year":"2016","journal-title":"J. Hosp. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"ofaa411","DOI":"10.1093\/ofid\/ofaa411","article-title":"Effectiveness of implementing a locally developed antibiotic use guideline for community-acquired cellulitis at a large tertiary care university hospital in thailand","volume":"7","author":"Sirijatuphat","year":"2020","journal-title":"Open Forum Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1093\/cid\/ciab181","article-title":"The impact of the auckland cellulitis pathway on length of hospital stay, mortality readmission rate, and antibiotic stewardship","volume":"73","author":"Ritchie","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1002\/jhm.2433","article-title":"Evidence-based care pathway for cellulitis improves process, clinical, and cost outcomes","volume":"10","author":"Yarbrough","year":"2015","journal-title":"J. Hosp. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1001\/archinternmed.2011.29","article-title":"Decreased antibiotic utilization after implementation of a guideline for inpatient cellulitis and cutaneous abscess","volume":"171","author":"Jenkins","year":"2011","journal-title":"Arch. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s13012-019-0951-x","article-title":"Action, actor, context, target, time (aactt): A framework for specifying behaviour","volume":"14","author":"Presseau","year":"2019","journal-title":"Implement. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1093\/jac\/dkaa001","article-title":"A behavioural approach to specifying interventions: What insights can be gained for the reporting and implementation of interventions to reduce antibiotic use in hospitals?","volume":"75","author":"Duncan","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1093\/jac\/dky222","article-title":"Driving sustainable change in antimicrobial prescribing practice: How can social and behavioural sciences help?","volume":"73","author":"Lorencatto","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_16","first-page":"CD006632","article-title":"Clinical pathways: Effects on professional practice, patient outcomes, length of stay and hospital costs","volume":"17","author":"Rotter","year":"2010","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1017\/cts.2020.16","article-title":"Designs and methods for implementation research: Advancing the mission of the ctsa program","volume":"4","author":"Hwang","year":"2020","journal-title":"J. Clin. Transl. Sci."},{"unstructured":"Australian Bureau of Statistics (2021, June 16). The Australian Statistical Geography Standard (Asgs) Remoteness Structure, Available online: http:\/\/www.abs.gov.au\/websitedbs\/D3310114.nsf\/home\/remoteness+structure.","key":"ref_18"},{"unstructured":"Resar, R., Griffin, F., Haraden, C., and Nolan, T. (2012). Using Care Bundles to Improve Health Care Quality, Institute for Healthcare Improvement.","key":"ref_19"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the public health impact of health promotion interventions: The re-aim framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am. J. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/j.cmi.2018.01.024","article-title":"Severe lower limb cellulitis: Defining the epidemiology and risk factors for primary episodes in a population-based case-control study","volume":"24","author":"Cannon","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"unstructured":"National Centre for Antimicrobial Stewardship and Australian Commission on Safety and Quality in Health Care (2021). Antimicrobial Prescribing Practice in Australian Hospitals Results of the 2019 Hospital National Antimicrobial Prescribing Survey, ACSQHC.","key":"ref_22"},{"unstructured":"Australian Commission on Safety and Quality in Health Care (2019). Aura 2019: Third Australian Report on Antimicrobial Use and Resistance in Human Health, ACSQHC.","key":"ref_23"},{"unstructured":"Green, J., and Thorogood, N. (2018). Qualitative Methods for Health Research, SAGE.","key":"ref_24"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/11\/1288\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:21:02Z","timestamp":1760167262000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/11\/1288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,22]]},"references-count":24,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["antibiotics10111288"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics10111288","relation":{},"ISSN":["2079-6382"],"issn-type":[{"type":"electronic","value":"2079-6382"}],"subject":[],"published":{"date-parts":[[2021,10,22]]}}}