- Research Methods &
- Research Training
- Research Into
|Title||Clinical management of skin and soft tissue infections in the U.S. Emergency Departments.|
|Publication Type||Journal Article|
|Year of Publication||2014|
|Authors||Mistry RD, Shapiro DJ, Goyal MK, Zaoutis TE, Gerber JS, Liu C, Hersh AL|
|Journal||West J Emerg Med|
|Date Published||2014 Jul|
|Keywords||Anti-Bacterial Agents, Community-Acquired Infections, Cross-Sectional Studies, Emergency Service, Hospital, Humans, Methicillin-Resistant Staphylococcus aureus, Practice Patterns, Physicians', Skin Diseases, Infectious, Soft Tissue Infections, Staphylococcal Skin Infections, United States|
INTRODUCTION: Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) has emerged as the most common cause of skin and soft-tissue infections (SSTI) in the United States. A nearly three-fold increase in SSTI visit rates had been documented in the nation's emergency departments (ED). The objective of this study was to determine characteristics associated with ED performance of incision and drainage (I+D) and use of adjuvant antibiotics in the management of skin and soft tissue infections (SSTI).
METHODS: Cross-sectional study of the National Hospital Ambulatory Medical Care Survey, a nationally representative database of ED visits from 2007-09. Demographics, rates of I+D, and adjuvant antibiotic therapy were described. We used multivariable regression to identify factors independently associated with use of I+D and adjuvant antibiotics.
RESULTS: An estimated 6.8 million (95% CI: 5.9-7.8) ED visits for SSTI were derived from 1,806 sampled visits; 17% were for children <18 years of age and most visits were in the South (49%). I+D was performed in 27% (95% CI 24-31) of visits, and was less common in subjects <18 years compared to adults 19-49 years (p<0.001), and more common in the South. Antibiotics were prescribed for 85% of SSTI; there was no relationship to performance of I+D (p=0.72). MRSA-active agents were more frequently prescribed after I+D compared to non-drained lesions (70% versus 56%, p<0.001). After multivariable adjustment, I+D was associated with presentation in the South (OR 2.36; 95% CI 1.52-3.65 compared with Northeast), followed by West (OR 2.13; 1.31-3.45), and Midwest (OR 1.96; 1.96-3.22).
CONCLUSION: Clinical management of most SSTIs in the U.S. involves adjuvant antibiotics, regardless of I+D. Although not necessarily indicated, CA-MRSA effective therapy is being used for drained SSTI.
|Alternate Journal||West J Emerg Med|
|PubMed Central ID||PMC4100857|