Abstract
BackgroundSkin and soft tissue infection (SSTIs) are commonly treated in emergency departments (EDs). While the precise role of antibiotics in treating SSTIs remains unclear, most SSTI patients receive empiric antibiotics, often targeted toward methicillin-resistant Staphylococcus aureus (MRSA). The goal of this study was to assess the efficiency with which ED clinicians targeted empiric therapy against MRSA, and to identify factors that may allow ED clinicians to safely target antibiotic use.MethodsWe performed a retrospective analysis of patient visits for community-acquired SSTIs to three urban, academic EDs in one northeastern US city during the first quarter of 2010. We examined microbiologic patterns among cultured SSTIs, and relationships between clinical and demographic factors and management of SSTIs.ResultsAntibiotics were prescribed to 86.1% of all patients. Though S. aureus (60% MRSA) was the most common pathogen cultured, antibiotic susceptibility differed between adult and pediatric patients. Susceptibility of S. aureus from ED SSTIs differed from published local antibiograms, with greater trimethoprim resistance and less fluoroquinolone resistance than seen in S. aureus from all hospital sources. Empiric antibiotics covered the resultant pathogen in 85.3% of cases, though coverage was frequently broader than necessary.ConclusionsThough S. aureus remained the predominant pathogen in community-acquired SSTIs, ED clinicians did not accurately target therapy toward the causative pathogen. Incomplete local epidemiologic data may contribute to this degree of discordance. Future efforts should seek to identify when antibiotic use can be narrowed or withheld. Local, disease-specific antibiotic resistance patterns should be publicized with the goal of improving antibiotic stewardship.
Highlights
Skin and soft tissue infection (SSTIs) are commonly treated in emergency departments (EDs)
Called “antibiograms”, these documents are important tools for use by front-line clinicians in making educated treatment decisions. They typically report aggregate data based on bacterial isolates from all sources, and infrequently delineate pathogens based on the age of the patient or the source of the infection
Because epidemiology and practice patterns are likely to differ in pediatric and adult patients, we examined management differences between children and adults in the ED with presumed-community-acquired soft tissue infections (SSTIs)
Summary
Skin and soft tissue infection (SSTIs) are commonly treated in emergency departments (EDs). Emergency department (ED) visits in the US for skin and soft-tissue infections (SSTIs) have more than tripled in number in recent decades, [1,2] mirroring the emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) [3,4]. Called “antibiograms”, these documents are important tools for use by front-line clinicians in making educated treatment decisions. They typically report aggregate data based on bacterial isolates from all sources (blood, skin, sputum, etc.), and infrequently delineate pathogens based on the age of the patient or the source of the infection. Children beyond the neonatal period have been considered high-risk for CA-MRSA SSTIs relative to adults, though as the CA-MRSA epidemic has matured, this distinction has become less clear [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
