Treatment failure outcomes for emergency department patients with skin and soft tissue infections

Larissa S May, Mark Zocchi, Catherine Zatorski, Jeanne A. Jordan, Richard E. Rothman, Chelsea E. Ware, Samantha Eells, Loren Miller

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: Skin 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. Methods: This 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 and 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. Results: We 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. Conclusion: Treatment failure was reduced by antibiotic use, whereas SSTI recurrence was associated with prior contact, SSTI, or use of packing.

Original languageEnglish (US)
Pages (from-to)642-652
Number of pages11
JournalWestern Journal of Emergency Medicine
Volume16
Issue number5
DOIs
StatePublished - 2015

Fingerprint

Soft Tissue Infections
Treatment Failure
Hospital Emergency Service
Skin
Recurrence
Drainage
Nucleic Acid Amplification Techniques
Anti-Bacterial Agents
Patient Discharge
Feasibility Studies
Erythema
Methicillin-Resistant Staphylococcus aureus
Abscess
Medical Records
Staphylococcus aureus
Fever
History
Pain
Wounds and Injuries
Infection

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Treatment failure outcomes for emergency department patients with skin and soft tissue infections. / May, Larissa S; Zocchi, Mark; Zatorski, Catherine; Jordan, Jeanne A.; Rothman, Richard E.; Ware, Chelsea E.; Eells, Samantha; Miller, Loren.

In: Western Journal of Emergency Medicine, Vol. 16, No. 5, 2015, p. 642-652.

Research output: Contribution to journalArticle

May, Larissa S ; Zocchi, Mark ; Zatorski, Catherine ; Jordan, Jeanne A. ; Rothman, Richard E. ; Ware, Chelsea E. ; Eells, Samantha ; Miller, Loren. / Treatment failure outcomes for emergency department patients with skin and soft tissue infections. In: Western Journal of Emergency Medicine. 2015 ; Vol. 16, No. 5. pp. 642-652.
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