Abstract
IntroductionSkin 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.MethodsThis 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.ResultsWe 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.ConclusionTreatment failure was reduced by antibiotic use, whereas SSTI recurrence was associated with prior contact, SSTI, or use of packing.
Highlights
Skin and soft tissue infections (SSTIs) are commonly evaluated in the emergency department (ED)
Treatment failure was reduced by antibiotic use, whereas SSTI recurrence was associated with prior contact, SSTI, or use of packing. [West J Emerg Med. 2015;16(5):642-652.]
We found treatment failure occurred in only 10.2% of our population who completed follow up, while recurrence occurred in approximately one-third of patients within three months
Summary
Skin and soft tissue infections (SSTIs) are commonly evaluated in the emergency department (ED). Skin and soft tissue infections (SSTIs) are common reasons patients seek medical care in the emergency department (ED).[1] Between 2006 and 2010, there were 34.8 million outpatient visits for SSTIs, one-third of which were seen in the ED.[2] Patients with cutaneous abscesses are more likely to be younger in age, of racial and ethnic minorities, and of low-income status.[3] there are many risk factors associated with SSTI acquisition, these infections commonly affect otherwise healthy individuals.[4]. In spite of the high incidence of SSTIs in ED settings, very little is known about factors associated with treatment failure and recurrence in these patients
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