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Trends in emergency department management of skin abscesses.
Am J Infect Control. 2015 Apr 01; 43(4):336-40.AJ

Abstract

BACKGROUND

Abscess is a distinct skin and soft tissue infection (SSTI) requiring incision and drainage (I&D). Previous national surveys combined all SSTIs to estimate abscess and evaluate management. We hypothesized that antibiotic rates are declining in response to evidence that antibiotics are unnecessary for most SSTIs requiring I&D.

METHODS

Emergency department (ED) patients included in the National Hospital Ambulatory Medical Care Survey from 2007-2010 with diagnosis codes for cutaneous abscess or SSTI were filtered using a procedure code for I&D available since 2007. The number of patients with SSTI, the percentage of patients receiving I&D, and the percentage of patients receiving antibiotics were determined. Antibiotics were characterized based on efficacy to methicillin-resistant Staphylococcus aureus (MRSA).

RESULTS

ED visits for SSTI increased from 3.55 million (95% confidence interval [CI], 3.24 million-3.86 million) in 2007 to 4.21 million (95% CI, 3.89 million-4.55 million) in 2010. Incidences of I&D rose from 736,000 (95% CI, 602,000-869,000) to 1.48 million (95% CI, 1.30 million-1.65 million) and comprised 32.2% of SSTI visits over the 4 years. In 2007, 85.1% (95% CI, 82.6%-87.7%) of patients received antibiotics after I&D with no change over 4 years. In 2010, 15.5% (95% CI, 12.1%-18.7%) received ≥2 antibiotics. Commonly prescribed antibiotics were trimethoprim-sulfamethoxazole (mean, 50.4%) followed by cephalexin (mean, 17.2%) and clindamycin (mean, 16.3%).

CONCLUSION

ED visits for SSTIs continue to rise. Despite mounting evidence, antibiotic use in SSTIs requiring I&D is high, and many patients receive multiple antibiotics, including drugs with no efficacy on MRSA.

Authors+Show Affiliations

Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA. Electronic address: mkprusakowski@carilionclinic.org.Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25726132

Citation

Prusakowski, Melanie K., and Damon R. Kuehl. "Trends in Emergency Department Management of Skin Abscesses." American Journal of Infection Control, vol. 43, no. 4, 2015, pp. 336-40.
Prusakowski MK, Kuehl DR. Trends in emergency department management of skin abscesses. Am J Infect Control. 2015;43(4):336-40.
Prusakowski, M. K., & Kuehl, D. R. (2015). Trends in emergency department management of skin abscesses. American Journal of Infection Control, 43(4), 336-40. https://doi.org/10.1016/j.ajic.2015.01.012
Prusakowski MK, Kuehl DR. Trends in Emergency Department Management of Skin Abscesses. Am J Infect Control. 2015 Apr 1;43(4):336-40. PubMed PMID: 25726132.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in emergency department management of skin abscesses. AU - Prusakowski,Melanie K, AU - Kuehl,Damon R, Y1 - 2015/02/25/ PY - 2014/10/23/received PY - 2015/01/09/revised PY - 2015/01/12/accepted PY - 2015/3/2/entrez PY - 2015/3/3/pubmed PY - 2016/2/4/medline KW - Abscess KW - Incision and drainage KW - Methicillin-resistant Staphylococcus aureus KW - Skin and soft tissue infection SP - 336 EP - 40 JF - American journal of infection control JO - Am J Infect Control VL - 43 IS - 4 N2 - BACKGROUND: Abscess is a distinct skin and soft tissue infection (SSTI) requiring incision and drainage (I&D). Previous national surveys combined all SSTIs to estimate abscess and evaluate management. We hypothesized that antibiotic rates are declining in response to evidence that antibiotics are unnecessary for most SSTIs requiring I&D. METHODS: Emergency department (ED) patients included in the National Hospital Ambulatory Medical Care Survey from 2007-2010 with diagnosis codes for cutaneous abscess or SSTI were filtered using a procedure code for I&D available since 2007. The number of patients with SSTI, the percentage of patients receiving I&D, and the percentage of patients receiving antibiotics were determined. Antibiotics were characterized based on efficacy to methicillin-resistant Staphylococcus aureus (MRSA). RESULTS: ED visits for SSTI increased from 3.55 million (95% confidence interval [CI], 3.24 million-3.86 million) in 2007 to 4.21 million (95% CI, 3.89 million-4.55 million) in 2010. Incidences of I&D rose from 736,000 (95% CI, 602,000-869,000) to 1.48 million (95% CI, 1.30 million-1.65 million) and comprised 32.2% of SSTI visits over the 4 years. In 2007, 85.1% (95% CI, 82.6%-87.7%) of patients received antibiotics after I&D with no change over 4 years. In 2010, 15.5% (95% CI, 12.1%-18.7%) received ≥2 antibiotics. Commonly prescribed antibiotics were trimethoprim-sulfamethoxazole (mean, 50.4%) followed by cephalexin (mean, 17.2%) and clindamycin (mean, 16.3%). CONCLUSION: ED visits for SSTIs continue to rise. Despite mounting evidence, antibiotic use in SSTIs requiring I&D is high, and many patients receive multiple antibiotics, including drugs with no efficacy on MRSA. SN - 1527-3296 UR - https://www.unboundmedicine.com/medline/citation/25726132/Trends_in_emergency_department_management_of_skin_abscesses_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-6553(15)00030-9 DB - PRIME DP - Unbound Medicine ER -