Practice patterns and management strategies for purulent skin and soft-tissue infections in an urban academic ED

Larissa S May, Katherine Harter, Kabir Yadav, Ryan Strauss, Jameel Abualenain, Amy Keim, Gillian Schmitz

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is the most common cause of purulent skin and soft-tissue infections (SSTIs) in the Unites States. Little is known regarding health care provider management strategies for abscesses in the emergency department (ED). Understanding variability in practice patterns could be an important step in implementing evidence-based guidelines. Objectives: The objectives of this study are to describe practice patterns for purulent SSTI in a single, urban, academic ED, including antibiotic selection and incision and drainage (I & D) technique, and to compare these practices with current evidence. Methods: Prospective data were collected on a convenience sample of adults presenting to our urban, academic ED (annual volume, 65 000 per year) between June 2009 and May 2010. Characteristics of patients and their providers were collected as well as specific management strategies including use of irrigation, packing, and antibiotics. Results: One hundred forty-five patients were enrolled. Most SSTIs were single (80.4% abscesses), most commonly on the extremities (29.8%). Both I & D and antibiotics were used 79.9% of the time, with the largest predictor for the addition of antibiotics being erythema more than 2 cm (odds ratio, 4.52; 95% confidence interval, 1.39-14.7); I & D technique varied by provider-type and experience. Providers suspected MRSA in 75% of cases, despite only 48% demonstrating MRSA on culture. Many patients received antimicrobials after I & D, even in those with 2 cm or less abscesses (57.5%). Conclusions: Practice patterns vary significantly, especially antibiotic overuse, at least in this urban academic ED. Further study should be undertaken to evaluate factors that influence management strategies for SSTI.

Original languageEnglish (US)
Pages (from-to)302-310
Number of pages9
JournalAmerican Journal of Emergency Medicine
Volume30
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

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Soft Tissue Infections
Practice Management
Hospital Emergency Service
Anti-Bacterial Agents
Methicillin-Resistant Staphylococcus aureus
Skin
Abscess
Erythema
Health Personnel
Drainage
Extremities
Odds Ratio
Guidelines
Confidence Intervals

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Practice patterns and management strategies for purulent skin and soft-tissue infections in an urban academic ED. / May, Larissa S; Harter, Katherine; Yadav, Kabir; Strauss, Ryan; Abualenain, Jameel; Keim, Amy; Schmitz, Gillian.

In: American Journal of Emergency Medicine, Vol. 30, No. 2, 02.2012, p. 302-310.

Research output: Contribution to journalArticle

May, Larissa S ; Harter, Katherine ; Yadav, Kabir ; Strauss, Ryan ; Abualenain, Jameel ; Keim, Amy ; Schmitz, Gillian. / Practice patterns and management strategies for purulent skin and soft-tissue infections in an urban academic ED. In: American Journal of Emergency Medicine. 2012 ; Vol. 30, No. 2. pp. 302-310.
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