Treatment Failure Outcomes for Emergency Department Patients with Skin and Soft Tissue Infections.
Publication/Presentation Date
9-1-2015
Abstract
INTRODUCTION: Skin and soft tissue infections (SSTIs) are commonly evaluated in the emergency department (ED). Our objectives were to identify predictors of SSTI treatment failure within one week post-discharge in patients with cutaneous abscesses, as well as to identify predictors of recurrence within three months in that proportion of participants.
METHODS: This was a sub-analysis of a parent study, conducted at two EDs, evaluating a new, nucleic acid amplification test (NAAT) for Staphylococcus aureus in ED patients. Patients≥18 years receiving incision and drainage (I&D) were eligible. Patient-reported outcome data on improvement of fever, swelling, erythema, drainage, and pain were collected using a structured abstraction form at one week, one month, and three months post ED visit.
RESULTS: We enrolled 272 participants (20 from a feasibility study and 252 in this trial), of which 198 (72.8%) completed one-week follow up. Twenty-seven additional one-week outcomes were obtained through medical record review rather than by the one-week follow-up phone call. One hundred ninety-three (73%) patients completed either the one- or three-month follow up. Most patients recovered from their initial infection within one week, with 10.2% of patients reporting one-week treatment failure. The odds of treatment failure were 66% lower for patients who received antibiotics following I&D at their initial visit. Overall SSTI recurrence rate was 28.0% (95% CI [21.6%-34.4%]) and associated with contact with someone infected with methicillin resistant S. aureus (MRSA), previous SSTI history, or clinician use of wound packing.
CONCLUSION: Treatment failure was reduced by antibiotic use, whereas SSTI recurrence was associated with prior contact, SSTI, or use of packing.
Volume
16
Issue
5
First Page
642
Last Page
652
ISSN
1936-9018
Published In/Presented At
May, L. S., Zocchi, M., Zatorski, C., Jordan, J. A., Rothman, R. E., Ware, C. E., Eells, S., & Miller, L. (2015). Treatment Failure Outcomes for Emergency Department Patients with Skin and Soft Tissue Infections. The western journal of emergency medicine, 16(5), 642–652. https://doi.org/10.5811/westjem.2015.7.26213
Disciplines
Medicine and Health Sciences
PubMedID
26587085
Department(s)
Fellows and Residents
Document Type
Article