A randomized clinical trial comparing use of rapid molecular testing for staphylococcus aureus for patients with cutaneous abscesses in the emergency department with standard of care

Larissa S May, Richard E. Rothman, Loren G. Miller, Gillian Brooks, Mark Zocchi, Catherine Zatorski, Andrea F. Dugas, Chelsea E. Ware, Jeanne A. Jordan

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

objective. To determine whether real-time availability of rapid molecular results of Staphylococcus aureus would impact emergency department clinician antimicrobial selection for adults with cutaneous abscesses. design. We performed a prospective, randomized controlled trial comparing a rapid molecular test with standard of care culture-based testing. Follow-up telephone calls were made at between 2 and 7 days, 1 month, and 3 months after discharge. setting. Two urban, academic emergency departments. patients. Patients at least 18 years old presenting with a chief complaint of abscess, cellulitis, or insect bite and receiving incision and drainage were eligible. Seven hundred seventy-eight people were assessed for eligibility and 252 met eligibility criteria. methods. Clinician antibiotic selection and clinical outcomes were evaluated. An ad hoc outcome of test performance was performed. results. We enrolled 252 patients and 126 were randomized to receive the rapid test. Methicillin-susceptible S. aureus–positive patients receiving rapid test results were prescribed beta-lactams more often than controls (absolute difference, 14.5% [95% CI, 1.1%–30.1%]) whereas methicillin-resistant S. aureus–positive patients receiving rapid test results were more often prescribed anti–methicillin-resistant S. aureus antibiotics (absolute difference, 21.5% [95% CI, 10.1%–33.0%]). There were no significant differences between the 2 groups in 1-week or 3-month clinical outcomes. conclusion. Availability of rapid molecular test results after incision and drainage was associated with more-targeted antibiotic selection.

Original languageEnglish (US)
Pages (from-to)1423-1430
Number of pages8
JournalInfection Control and Hospital Epidemiology
Volume36
Issue number12
DOIs
StatePublished - 2015

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Standard of Care
Abscess
Staphylococcus aureus
Hospital Emergency Service
Randomized Controlled Trials
Skin
Anti-Bacterial Agents
Drainage
Insect Bites and Stings
Methicillin Resistance
Methicillin
Cellulitis
beta-Lactams
Telephone

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

A randomized clinical trial comparing use of rapid molecular testing for staphylococcus aureus for patients with cutaneous abscesses in the emergency department with standard of care. / May, Larissa S; Rothman, Richard E.; Miller, Loren G.; Brooks, Gillian; Zocchi, Mark; Zatorski, Catherine; Dugas, Andrea F.; Ware, Chelsea E.; Jordan, Jeanne A.

In: Infection Control and Hospital Epidemiology, Vol. 36, No. 12, 2015, p. 1423-1430.

Research output: Contribution to journalArticle

May, Larissa S ; Rothman, Richard E. ; Miller, Loren G. ; Brooks, Gillian ; Zocchi, Mark ; Zatorski, Catherine ; Dugas, Andrea F. ; Ware, Chelsea E. ; Jordan, Jeanne A. / A randomized clinical trial comparing use of rapid molecular testing for staphylococcus aureus for patients with cutaneous abscesses in the emergency department with standard of care. In: Infection Control and Hospital Epidemiology. 2015 ; Vol. 36, No. 12. pp. 1423-1430.
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abstract = "objective. To determine whether real-time availability of rapid molecular results of Staphylococcus aureus would impact emergency department clinician antimicrobial selection for adults with cutaneous abscesses. design. We performed a prospective, randomized controlled trial comparing a rapid molecular test with standard of care culture-based testing. Follow-up telephone calls were made at between 2 and 7 days, 1 month, and 3 months after discharge. setting. Two urban, academic emergency departments. patients. Patients at least 18 years old presenting with a chief complaint of abscess, cellulitis, or insect bite and receiving incision and drainage were eligible. Seven hundred seventy-eight people were assessed for eligibility and 252 met eligibility criteria. methods. Clinician antibiotic selection and clinical outcomes were evaluated. An ad hoc outcome of test performance was performed. results. We enrolled 252 patients and 126 were randomized to receive the rapid test. Methicillin-susceptible S. aureus–positive patients receiving rapid test results were prescribed beta-lactams more often than controls (absolute difference, 14.5{\%} [95{\%} CI, 1.1{\%}–30.1{\%}]) whereas methicillin-resistant S. aureus–positive patients receiving rapid test results were more often prescribed anti–methicillin-resistant S. aureus antibiotics (absolute difference, 21.5{\%} [95{\%} CI, 10.1{\%}–33.0{\%}]). There were no significant differences between the 2 groups in 1-week or 3-month clinical outcomes. conclusion. Availability of rapid molecular test results after incision and drainage was associated with more-targeted antibiotic selection.",
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