Risk factors for antibiotic misuse for cellulitis in the emergency department through the SARS-CoV-2 pandemic: A single institute retrospective study

Cellulitis has a large burden on emergency departments (EDs) annually in the United States both in case volume and recurrence, causing antibiotic waste and poorer patient outcomes. To identify medical and demographic risk factors independently associated with antibiotic overprescription for cellulitis in the ED, we employed a retrospective cohort study utilizing electronic health records on patients with cellulitis-like symptoms in the ED from 2016 to 2023. Demographics, such as race, ethnicity, insurance status, and comorbidities were matched and reviewed alongside patient medical records to determine the over-prescribed cohort. A total of 1,283 (9%) of 13,530 patients were over-administered antibiotics for cellulitis-like-symptoms in the ED. Multivariate analysis showed that white, non-Latinx heritage (Relative risk (RR)=1.60; p<0.0001) and private insurance status (RR= 1.58; p<0.0001) patients were the most at risk for inappropriate antibiotic administration. Patients with chronic pulmonary disease (RR= 1.39; p<0.0001) had the strongest independent medical association with antibiotic over-administration. While this is a retrospective study limited to one institution’s patient population, our results demonstrate that antibiotic administration practices for cellulitis in the ED is significantly associated with patient race and insurance status, reflecting current health disparities.