(EBP-011) Systemic and topical antimicrobial prescribing trends in outpatient wound care: Observational multi-centric study from 1447 baseline wound assessments.

Jill Schroder, MSOM – Sr. Vice President, Operations, SerenaGroup; Thomas Serena, MD – CEO & President, SerenaGroup; Scott Johnson, MD – Medical Director, Wound Care & Hyperbaric Medicine, Ascension Via Christi | SerenaGroup

Introduction: Wound care has one of the highest rates of systemic antibiotic use across medical fields. This applies to systemic as well as topical antimicrobial use, both of which are widespread. Recent Joint Commission guidelines have mandated that hospital outpatient wound care centers develop and implement an antimicrobial stewardship program. However, more understanding on baseline prescribing practices and rates in the US is a critical first step toward rational antimicrobial/antibiotic use.

Methods:

Prospective study, conducted across 8 outpatient wound clinics, form Jan-Dec 2022. Data from single time-point, consecutive initial visits was recorded. Including clinical findings, antimicrobial prescribing trends and sampling practices. 

Results: 1438 wounds suitable for analysis after excluding 9 that had healed at time of assessment. Of those, 964 were assessed by clinical examination alone (SoC) and 474 by clinical examination in combination with fluorescence imaging (SoC+FL). Prescribing was clinically supported in 68.2% of the SoC+FL arm and in 61.8% of the SoC arm. However other non-clinical considerations were not accounted for. Overall, each one of the prescribed patients in the SoC arm was prescribed more concurrent medications during that initial visit than those in the SoC+FL arm (1.4 versus 1/patient respectively). Items prescribed were preferentially topical in the FL+SoC 92% vs. 64%, p >0.0001) arm while systemic antibiotics composed 36% of the single items prescribed in the SoC cohort (versus 8% in FL+SoC, p< 0.0001).

Discussion: Fluorescence imaging promotes topical and local wound care by providing objective and actionable information at the bedside. Antibiotic stewardship programs could benefit from the support of validates aids and technologies that decrease unsupported systemic prescribing.

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