216 Retrospective Study on Current Treatment for Uncomplicated Abscesses in Los Angeles County Emergency Departments from 2016-2017

Abstract

Uncomplicated skin abscesses are common and remain one of the leading causes of skin and soft tissue infections in the United States. Recent data from our local institutions in Los Angeles (LA) County states that a short course of a single drug anti-staphylococcal oral antibiotic has benefit over no antibiotics. We analyzed multiple LA hospitals within our system to determine whether current practices are following the most up to date evidence-based recommendations. Here we present the initial data and findings from our study. Data was obtained using ICD-10CM diagnosis codes for abscesses from 11/1/2016 to 11/1/2017 from our electronic medical record system. Patients ≥18 y/o were included if presenting with uncomplicated abscesses on extremities, buttocks, and thorax which then underwent bedside incision and drainage in the ED with subsequent discharged. Demographics including age, sex, race, co-morbid conditions, and insurance coverage were collected. Any abscess that required surgical excision, drainage in the operating room, or abscess located in the following areas: breast, urological, gynecology, diabetic foot, face/mandible were excluded. Our goal was to collect 200 patients from each hospital in the LA County system. Of the 400-patients reviewed so far, the mean and median age was 40 years with interquartile range of 28-51. The data demonstrated 64% were male, predominantly Hispanic, with one site having a statistically higher number of African Americans, drug users, cancer diagnosis, and liver disease. 70.1% of patients were insured by Medicaid, 12.5% non-Medicaid insurance, 17.4% had no-insurance. Only 50% of patients received a recommended single anti-staphylococcal drug (TMP-SMX, clindamycin, doxycycline) deemed to be an appropriate drug choice. 31% received excessive therapy with two agents (most commonly TMP-SMX with cephalexin). 12% of patients received no antibiotics on discharge. A significant proportion of patients at our large safety net hospital failed to receive evidence based best abscess management with short course single anti-staphylococcal antibiotic. This despite our hospitals being a large contributor to the current evidence for short course antibiotics. The results reveal that a large proportion of emergency medicine providers continue to prescribe dual therapy despite evidence suggesting single drug therapy is adequate.