Skin, soft tissue infection treatments differ by race
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Implicit racial bias could play a part in antibiotics prescribed for skin and soft tissue infections, according to a research letter published in JAMA Network Open.
“While emergent data suggest that racial differences and disparities in medical therapy exist for common other health conditions like diabetes and hypertension, racial differences have not been previously investigated in antibiotic choice for infections like [skin and soft tissue infections (SSTI)],” Alysse G. Wurcel, MD, MS, assistant professor in the department of medicine’s division of geographic medicine and infectious diseases at Tufts Medical Center and the study’s first author, told Healio.
SSTI are being treated more commonly with antibiotics, with B-lactams, such as cefazolin, being used as first-line therapy and alternative treatments, such as clindamycin, being seen as inferior, according to the study’s authors.
A cohort study of 1,242 adult patients (45% women; mean age, 58 years; 18% Black; 69% white) treated for SSTI at 91 U.S. hospitals found Black patients were more likely to receive clindamycin compared to white patients, while white patients were more likely to be prescribed cefazolin.
Of 854 white patients, 114 received cefazolin, compared to 11 of 224 Black patients (13% vs. 5%; P < .001).
Clindamycin was given to 62 white patients and 27 Black patients (7% vs. 12%; P = .02).
“Race was associated with differential management of SSI, with Black inpatients less likely to receive cefazolin and more likely to receive clindamycin than white inpatients,” Wurcel said.
“We do not know why different antibiotics were chosen for Black patients and white patients, and given adjustment for many factors, it may be related to implicit bias,” Kimberly G. Blumenthal, MD, MSc, co-director of the clinical epidemiology program at Massachusetts General Hospital, assistant professor at Harvard Medical School and one of the study’s authors, told Healio.
The two most prescribed treatments — piperacillin-tazobactam and vancomycin — did not differ by race, with 132 (15%) white patients and 32 (14%) Black patients receiving the former and 305 (36%) white patients and 66 (29%) Black patients receiving the latter.