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" Treatment Failure Outcomes for Emergency Department Patients with Skin and Soft Tissue Infections "
May, Larissa S.; Zocchi, Mark; Zatorski, Catherine; Jordan, Jeanne A.; Rothman, Richard E.; Ware, Chelsea E.; Eells, Samantha; Miller, Loren
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AL
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| Record Number
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933497
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LA1r65w75k
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| Language of Document
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English
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| Main Entry
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May, Larissa S.; Zocchi, Mark; Zatorski, Catherine; Jordan, Jeanne A.; Rothman, Richard E.; Ware, Chelsea E.; Eells, Samantha; Miller, Loren
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| Title & Author
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Treatment Failure Outcomes for Emergency Department Patients with Skin and Soft Tissue Infections [Article]\ May, Larissa S.; Zocchi, Mark; Zatorski, Catherine; Jordan, Jeanne A.; Rothman, Richard E.; Ware, Chelsea E.; Eells, Samantha; Miller, Loren
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| Title of Periodical
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Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
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16/5
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| Date
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2015
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| Abstract
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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.
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